Dysphagia

Causes of Dysphagia

CA Oesophagus

from Bailey 27th

Survival is poor

  • Present with Dysphagia (food sticking in chest after swallowing, in bulbar and cns disorders unable to swallow)
  • Regurgitation
  • Vomiting
  • LOW

Features of Advanced malignancy

Think of up, down, ant and posterior.

  • Haemetemesis, melaena
  • Recurrent laryngeal nerve palsy (hoarseness)
  • Interscapular pain
  • Diaphragm pralysis
  • L supraclavicular lymphadenopathy (Virchow’s node ; is a bad prognostic factor)

Upper 2/3 : Squamous cell CA (smoking, alcohol are risk factors)

Lower 1/3 : AdenoCA (GORD, Obesity)

Staging is necessary for curative treatment.

Ix

  • Endoscopy (only mucosal surface can be examined)
  • CT chest and abdomen to stage the disease.
  • TNM staging

Management

  • Chemoradiotherapy for squamous cell CA
  • Radical oesophagectomy
  • or palliation : stenting

6 Drains after oesophagectomy

  1. NG Tube
  2. CV line
  3. L IC tube
  4. R IC tube
  5. Abdominal drain
  6. Feeding jejunostomy
  7. Catheter
  8. Cannula