Dysphagia

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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224 Dysphagia

Instruction

This patient has difficulty in swallowing; would you like to ask her a few questions and examine her?

Salient features

History

• Ask about the following:

• The duration of symptoms: progressive dysphagia over months or weeks suggests the presence of organic narrowing (carcinoma esophagus, stricture from ongoing reflux esophagitis)
• Whether the difficulty is in swallowing liquids or solids, or both. (liquids first then motility disorder, solids first then suspect oesophageal stricture)
• Nasal regurgitation
• Whether or not the patient coughs on swallowing
• Is it difficult to make the swallowing movement (bulbar palsy)
• Is the swallowing painful: odynophagia (oesophageal ulcer, spasm or cancer)
• Is it intermittent (spasm of oesophagus)?
• The level at which the food sticks (suprasternal notch or midsternal)
• Does the neck distend or gurgle on swallowing (pharyngeal pouch)?
• Associated heart burn
• Weight loss.

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