Dysphagia
| Headline | |
|---|---|
| History | Clarify speed of onset Are they septic? 1. Solids, liquids, saliva? (solids then liquids ⇒ stricture) ⇒ motility disorder 2. Difficult to initiate swallowing? i.e. bulbar palsy? 3. odynophagia? ⇒ cancer, ulcer, Candida, spasm 4. intermittent or constant and worsening? intermittent: spasm? else: malignant stricture? 5. Bulging/gurgling on drinking? ⇒ pharyngeal pouch 6. Progression? Risk factors? (smoking/alcohol excess) Paeds - unimmunised children may have diphtheria (!!!!!) or epiglottitis ALARMS symptoms: anaemia, loss of weight, anorexia, recent progression, malaena/haematemesis, swallowing difficulty |
| Examination | Cachexia, anaemia, supraclavicular nodes (Virchow’s node), systemic disease Thyroid o/e Neurological o/e - Parkinsonism, MND, Myasthenia Swallow screen |
| Diagnostic investigations | Consider: FBC, U&Es, CXR, OGD, Barium swallow |
| Differentials | Extraluminal: goitre, lung/secondary cancer Intramural: achalasia, spasm, stroke, pharyngeal pouch, systemic scleroderma, stroke, stricture, candid Intraluminal: foreign body, oesophageal cancer, candida |
| Immediate management | Airway compromise - you know what to do Shocked/dehydrated - fluid resuscitate |
| Ongoing management |