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Gastrointestinal History
 
 
 

Dysphagia

 
 

Overview

  • Dysphagia refers to difficulty swallowing; this may be caused by pathology affecting the mouth, oropharynx, or oesophagus. The particulars of the difficulty swallowing and particularly the timing of the difficulty within the swallow can aid in narrowing down the cause.
    • Ask About

    • Difficulty swallowing
    • Sensation of food stuck in throat
    • Swallowing more than once to get a bite down
    • Coughing with meals
    • Regurgitating food

Aetiology

    • Causes of Dysphagia

    • Oral Cavity

    • Poor dentition
    • Tumour
    • Trauma
    • Xerostomia - Sjögren’s, antihistamines, antipsychotics, diuretics, radiation, mouth breathing, dehydration, diabetes, alpha blockers, ACEis, ATII blockers, opiates
    • Amyloidosis of the tongue
    • Oropharyngeal

    • Tumour
    • Stenosis - radiation, surgery, chemical irritation
    • Infection - viral / bacterial
    • Extrinsic compression - cervical lymphadenopathy, thyroid enlargement
    • Neurological - stroke, Parkinson’s, ALS, MS, CNS tumour, TBI, Alzheimer’s, cerebral palsy
    • Neuromuscular - myasthenia gravis, muscular dystrophy, inflammatory myopathies
    • Trauma - blunt, penetrating, extrinsic compression from swelling
    • Zenker’s diverticulum
    • Oesophageal

    • Foreign body
    • Tumour - oesophageal carcinoma, metastasis
    • Extrinsic compression - mediastinal / lung mass, cervical osteophytes
    • Stricture - reflux, chemical irritation (potassium, NSAIDS, alendronate, antibiotics), radiation
    • Inflammation - erosive oesophagitis, eosinophilic oesophagitis
    • Neuromuscular - achalasia, scleroderma, oesophageal spasm, inflammatory myopathies
    • Hiatus hernia
    • Oesophageal ring
    • Oesophageal web
    • Other

    • Psychogenic dysphagia

History of Presenting Complaint

    • Onset

      Whether the dysphagia began suddenly or gradually, and in what situation.
    • Sudden onsetSuggestive of obstruction or oesophagitis
    • Progressive dysphagiaSuggestive of neuromuscular cause
    • Type of Food

      Whether the dysphagia is worse with certain foods.
    • Dysphagia of solids onlySuggestive of mechanical cause
    • Dysphagia of solids and liquidsSuggestive of neuromuscular cause
    • Dysphagia of cold foodsSuggestive of neuromuscular cause
    • Phase of Swallow

      What part of swallowing the patient has difficulty with.
    • Difficulty initiating swallowSuggestive or oral or oropharyngeal cause
    • Sensation of food stuck in throatSuggestive of oesophageal cause
    • Coughing During Meals

      Whether the patient coughs during or after swallowing.
    • Coughing early in swallowSuggestive of neuromuscular cause
    • Coughing late in swallowSuggestive of obstructive cause
    • Regurgitation

      Whether food comes back up after meals.
    • Regurgitation of foodMay be indicative of achalasia
    • Regurgitation of old foodMay be indicative of Zenker’s diverticulum
    • Associated Symptoms

      Whether the dysphagia is associated with any other symptoms.
    • Muscular weaknessSuggestive of neuromuscular cause
    • HalitosisSuggestive of Zenker’s diverticulum
    • HeartburnSuggestive of hiatus hernia, reflux or eosinophilic oesophagitis
    • Weight lossRed flag for malignancy
    • Alleviating Factors

      Whether there is anything that improves the dysphagia.
    • Relieved with repeated swallowingSuggestive of foreign body or achalasia
Last updated on November 28th, 2019
 
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