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Dysphagia Differential Diagnosis

Dysphagia

Carcinoma of the Oesophagus

  • Progressive dysphagia initially for solids, then for liquids
  • Associated regurgitation of undigested food
  • Loss of weight  in spite of good appetite
  • Initially LOW then develop LOA may indicate to lower oesophageal CA spreading to Stomach
  • Features of local spread -haematemesis and
    melaena, hoarseness of voice(CA of upper oesphagus.), interscapular pain
  • History of hiccups – Diaphragm irritation
  • Features of distant spread
    • Neck lumps
    • Liver – Jaundice, RHC pain
    • Lungs – persistent dry cough, SOB, coughing up of blood
    • Brain – Early morning headache vomiting, adult-onset seizure
    • Bone – intractable backache, bone pain
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Benign Oesophageal strictures

  • Peptic
    • Intermittent progressive dysphagia
    • Long Hx of symptoms
    • Hx of burning pain which is worse in recumbency / bending down (GORD)
  • Other
    • Ingestion of corrosive substances
    • Exposure to radiation (radiotherapy)

Achalasia

  • Dysphagia for solids and liquids both.
  • Longer duration of symptoms.
  • Liquid >solids, dysphagia relieved by changing posture.
  • Can have intermittent dysphagia which later become progressive
  • Loss of weight
  • Halitosis
  • Regurgitation of undigested food specially at night when lying flat.
  • Ask for episodes of noturnal cough and aspiration
  • High fever,recurrent chest infections

Scleroderma

  • Hx of changes in the skin, around lips, in fingers, past Hx of Renaud’s phenomena
dysphagia
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