Points in the history
- some clinical features that may be associated with dysphagia include:
- coughing and choking while or soon after eating or drinking
- wet sounding voice associated with eating
- chest congestion after eating or drinking
- slow eating
- a single mouthful of food taken in as multiple swallows
- extra effort while chewing or swallowing
- tiredness while eating
- rise of temperature thirty minutes to an hour after eating
- weight loss
- change in laryngeal sensation
- food coming out of the nose
- pain while swallowing
- feeling of a lump in the throat
- recurrent pneumonia
- the folowing specific points in the history obtained about a dysphagic patient are also diagnostically helpful:
- regarding the swallowing of fluid:
- if the patient can swallow fluid as quickly as usual but has difficulty with food apparently getting stuck, then suspect a stricture. It may be benign or malignant.
- if the patient cannot swallow fluid as quickly as usual, then this suggests that there is either a motility disorder such as achalasia, a neurological disorder, or a severely narrowed oesophageal lumen
- if the neck bulges or gurgles on drinking, then suspect a pharyngeal pouch
- regarding the movement of swallowing
- if constant and painful then suspect a malignant stricture
- the rapidity of onset is important - see aetiology
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