2. Does congenital hypertrophic pyloric stenosis run in families?
Correct answer: It is a familial condition.
1. What is the aetiology of congenital hypertrophic pyloric stenosis?
Correct answer: The aetiology of the pyloric muscle ‘tumour’ in pyloric obstruction in infants is unknown. It may result from an abnormality of the ganglion cells of the myenteric cells; failure of the sphincter to relax may then produce an…
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).
