Dysphagia: Pathophysiology, Causes, Classic Findings, and Diagnostic Approach

Vocabulary flashcards covering the pathophysiology, structural and neuromuscular causes, classic findings, and diagnostic approach to oropharyngeal and esophageal dysphagia based on the lecture notes.

Oropharyngeal Dysphagia

Difficulty initiating swallowing caused by structural outpouching or neuromuscular dysfunction, leading to an inability to propel foods and fluids into the esophagus. Associated with drooling, regurgitation, choking, and coughing as signs of possible nasopharyngeal reflux and aspiration.

Esophageal Dysphagia

The sensation of food being stuck in the esophagus caused by esophageal obstruction or neuromuscular dysfunction, leading to an inability to move foods and fluids through the esophagus. Associated with heartburn, chest pain, and regurgitation.

Zenker's Diverticulum

A structural outpouching above the upper esophageal sphincter associated with weakness of inferior pharyngeal constrictors and increased intraluminal pressure; characteristically presents with halitosis and regurgitation.

Myasthenia Gravis

A neuromuscular cause of oropharyngeal dysphagia associated with decreased pharyngeal muscle contraction secondary to autoantibodies attacking acetylcholine receptors at the neuromuscular junction; presents with dysarthria, diplopia, and extraocular muscle weakness.

Esophagitis / Esophageal Strictures

A structural cause of esophageal dysphagia caused by inflammation and fibrosis of the esophageal lining, leading to narrowing of the esophageal lumen; requires evaluation for a history of chronic GERD.

Esophageal Webs

An asymmetric thin membrane protruding into the upper esophagus lumen causing narrowing of the lumen; associated with Plummer-Vinson syndrome.

Plummer-Vinson Syndrome

A condition characterized by the clinical triad of iron deficiency anemia, dysphagia, and esophageal webs.

Schatzki Rings

A circular thin membrane that protrudes into the lower esophagus lumen, causing lumen narrowing; evaluated for an association with chronic GERD.

Esophageal Cancer

A structural cause of esophageal dysphagia where an esophageal mass obstructs the esophageal lumen; presents with difficulty moving food/fluids and requires assessment for anemia and weight loss.

Achalasia

A neuromuscular disorder caused by decreased activity of the myenteric plexus in the esophagus, leading to decreased peristalsis of the mid-distal esophagus and increased lower esophageal sphincter (LES) tone, resulting in a 'Bird's Beak Appearance' on barium swallow.

Diffuse Esophageal Spasm

A neuromuscular cause of esophageal dysphagia due to abnormal myenteric activity, resulting in increased peristalsis of the mid-distal esophagus with normal lower esophageal sphincter (LES) tone; produces a corkscrew appearance on barium swallow and may present with severe chest pain.

Scleroderma (Esophageal Involvement)

A neuromuscular cause of esophageal dysphagia involving atrophy and fibrosis of the esophageal muscle, resulting in decreased peristalsis of the mid-distal esophagus and decreased lower esophageal sphincter (LES) tone.

CREST Syndrome Findings

Clinical features associated with scleroderma comprising Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia.

Barium Swallow

An initial diagnostic imaging test for dysphagia used to identify Zenker's diverticulum in oropharyngeal dysphagia, as well as structural or functional esophageal abnormalities (e.g., corkscrew appearance or bird's beak appearance).

Esophageal Gastroduodenoscopy (EGD)

A diagnostic endoscopic procedure used in esophageal dysphagia to assess specific structural causes (esophagitis, strictures, Schatzki rings, esophageal cancer) and rule out neuromuscular etiologies.

Esophageal Manometry

A diagnostic modality used to assess specific neuromuscular causes of esophageal dysphagia by measuring peristalsis and lower esophageal sphincter (LES) pressure patterns.

Chagas Disease

An infection secondary to Trypanosoma cruzi that should be assessed for causing Achalasia, Toxic Megacolon, and Dilated Cardiomyopathy.