Dysphagia Differential Diagnosis
Dysphagia
Carcinoma of the Oesophagus
- Progressive dysphagia initially or 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 oesp.), 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
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 skin, around lips, in fingers , past Hx of renaud’s phenomina
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