Dysphagia

Note: esophagus doesn’t have serosa; narrows at UES, Left mainstem bronchus and Aortic arch, and LES

History

  • What: solids vs liquids
  • When: intermittent, unremitting
  • Where: does it feel like the food is getting stuck
  • Associated symptoms: voice change, difficulty speaking/breathing heartburn, weight loss, fevers, night sweats
  • Risk factors: irradiation, smoking

Physical exam: Virchow’s node, liver enlargement

  • Remember to feel inside mouth
  • Do a concentrated exam on neck, thorax (think of where esophagus goes!) and abdomen

Motor causes: achalasia (atrophy/loss of ganglions, non progressive, manometry, Barium swallow shows bird’s beak esophagus), DES

Non-Motor causes: benign (strictures – caustic injuries, Schatzki’s rings; webs) vs malignant (esophageal cancer: adenocarcinoma and squamous cell)

Imaging – Barium swallow first – check for a Zenker’s, then safe to scope

Esophageal cancers

  • Most common types of esophageal cancer are squamous cell carcinoma and adenocarcinoma.
  • Approximately 60% of squamous cell carcinomas develop in the middle third of the organ, 30% occur in the lower third, and 10% occur in the upper third.
  • Adenocarcinoma develops in the lining of the esophagus and is associated with a condition called Barrett’s esophagus. This type usually occurs in the lower third of the esophagus.

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