1. Dysphagia
Ben Savage

2. Objectives
 What is dysphagia
 History
 Examination
 Tests
 Differential diagnosis

3. What is dysphagia
 Dysphagia is a difficulty swallowing
 Causes are:
 Oral
 Pharyngeal
 Oesophageal
 The causes can be mechanical or motility
related.

5. History
 Take a full detailed history
 Key questions for PC

Was there difficulty with swallowing solids and liquids from
the onset?

Is it difficult to make swallowing movement?

Is swallowing painful? (odynophagia)

Is dysphagia intermittent or constant and getting worse?

Does the neck bulge or gurgle on drinking?
 Other key areas are PMH and FH

6. Examination
 Relevant examination, GI, Neuro.
 Look for signs of systemic illness
 Do they look cachectic or anaemic
 Feel neck and supraclavicular lymph nodes.
 Virchow’s node L supraclavicular and suggests
intra-abdo malignancy
 Palpable abdominal masses

7. Tests
 Bloods
 FBC, U&E, LFT, TFT, Serum Glucose, CRP
 CXR
 Barium sallow
 Endoscopy +/- biospy
 CT/MRI

8. Differential Diagnosis
 Mechanical Block can occur in 3 places:
 In the lumen:

Foreign body obstruction- ill fitting dentures

Pharyngeal pouch
 In the wall:

Malignant

Benign – oesophageal ring
 External pressure:

Lung cancer

Vascular – Aortic aneurysm, left atrial enlargement

9. Differential Diagnosis
 Motility disorders
 Achalasia
 Diffuse oesophageal spasm
 Cerebrovascular incident
 Bulbar palsy
 Myasthenia gravis
 Other
 Oesophagitis – infection, reflux

10. Thank you
Any Questions