13. What are the reasons for people swallowing foreign bodies?
Correct answer: Foreign bodies are swallowed either accidentally, usually by children, or deliberately by mentally disturbed people, prison inmates and circus sideshow performers. A recent phenomenon is a ‘body-packer’, a smuggler who swallows condoms packed with cocaine or heroin. These…
12. Why might a barium swallow be used to investigate dysphagia?
Correct answer: Barium swallow, with cine-radiography, may demonstrate the characteristic appearances of a cervical web, extrinsic compression and the dilated oesophagus of achalasia.
11. What special investigations would you use to investigate dysphagia?
Correct answer: Barium swallow and fibreoptic oesophagoscopy (which enables biopsy).
10. What should you look for on examination of a patient with dysphagia?
Correct answer: Often this is negative, but search is made for clinical evidence of Plummer–Vinson syndrome (a smooth tongue, anaemia and koilonychia); secondary nodes from a carcinoma of the oesophagus may be felt in the neck and supraclavicular fossae; and…
9. What do you need to elicit from the history of dysphagia?
Correct answer: The subjective site of obstruction is not always exact; the patient often merely points vaguely to behind the sternum. The diagnosis may be given by a history of swallowed caustic in the past. A previous story of reflux…
8. What are the general causes of dysphagia?
Correct answer: (1) Bulbar palsy. (2) Hysteria. (3) Bulbar poliomyelitis. (4) Myasthenia gravis. (5) Diphtheria.
7. What are the causes of dysphagia originating outside the oesophagus?
Correct answer: (1) Bronchial carcinoma. (2) Retrosternal goitre. (3) Aortic aneurysm in the thorax. (4) Node pressure from malignancy.
6. What are the causes of dysphagia within the oesophagus wall?
Correct answer: (1) Congenital atresia. (2) Inflammatory stricture – secondary to reflux oesophagitis. (3) Caustic stricture. (4) Achalasia. (5) Plummer–Vinson syndrome with oesophageal web. (6) Pharyngeal pouch. (7) Tumour of the oesophagus or cardia (8) systemic sclerosis (scleroderma).
4. What are the local causes of dysphagia?
Correct answer: (1) In the lumen: foreign body.(2) In the wall: congenital atresia; inflammatory stricture – secondary to reflux oesophagitis; caustic stricture; achalasia; Plummer-Vinson syndrome with oesophageal web; pharyngeal pouch; Schatzki ring; tumour of oesophagus or cardia; systemic sclerosis (scleroderma).(3)…
