barium swallow and endoscopy-2 - library
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barium swallow and endoscopy-2 - library
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02-02-2006, 01:05 AM
63 yo with h/o dysphagia for both solid and liquid for 2 months, 6 lb loss. past: TIA 6 months ago, pneumonia 3 months ago, and chonic heartburn treated with over counter antacids. PE: mild epigastric tender. normal xray.
most approapriate next step in dx? a, endoscopy b, barium swallow c, motility study d, 24 hour PH monitering
02-02-2006, 01:34 AM
B.BS is the next step
She has dysphagia w both solid & liquid-- Achalasia. The most accurate dx test is esophageal manomatry. Never answer Endoscopy for pt that u think dx is Achalasia bc the esophageal mucosa is normal in this dz.
02-02-2006, 07:32 AM
for motility study, u must think of dx Scleroderma.but the prominent sx of scleroderma is REFLUX. Correct me if i'm wrong.
02-02-2006, 07:36 AM
B- barium swallow should always be done first... followed with esophagoscopy.
02-02-2006, 11:53 AM
Clue: Dysphagia to solid and liquids simultaneously gives hint of Motitlity problem rather than mechanical.
3 diseases of motiltiy problems are: Achalasia, DES, and Scleroderma Nothing in the History suggests Scleroderma, so I would also go with Motility study will confirm if achalasia but also differentiate if it is scleroderma Let us know the answer
02-02-2006, 05:00 PM
Hi Library,
Taking it in April. Can't wait to get it over with. Is there and explanation to your question. Would be great to know. Obvioulsy I am still getting a little confused about barium swallow and motility studies. maybe u can shed some light. Will also post some questions here soon. How about u , when are you planning to take it? I guess april 17 was right. Does it mean if barium comes back inconclusive we would then go for manometry?
02-02-2006, 06:08 PM
Hi Ben,
according to Dr Fisher in 2005 kaplan video-GI part: -2 dz that do not need endoscope bc the esophageal mucosa is normal. So Scope not help: 1. Achalasia 2. (Schatzki's)Ring & Webs (Plummer-Vinson syndrome)----NO progressive dysphagia, distinguish feature fr. Achalasia. -1 dz that contraindicate scope: Zenker diverticulum. -1 dz that Barium study is not neccessary: Scleroderma i still not very clear about these dx test & dz. But hope this help. |
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