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barium swallow and endoscopy-2 - library
#11
Hi April17
Thanks for your explanation. And I agree on all other parts except that Kornbluth says sleroderma and rings also develop over time causing dysphagia to both.
Endoscopy only if obstruction is suspected.
Looking at the question again pat.
-Older
-Dyspahia to both for 2 mo w/6lb weightloss
-And Tx for Heartburn (so has reflux probls)
-normal Xray

Still don;t get why manometry not first unless barium esophagram is first b/c its less expensive and has not been done in patient previoulsy.

Anyone else has input?

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#12
For rings & Web, i mean pt does have dysphagia, but not worse over time.
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#13
yes rings and web actually give intemittent dysphagia not assoc with pain compared to DES or Nutcrackers intermittent chest pain and dysphagia associated with pain but unrelated pain with food.
Also complication of achalasia and Gerd is peptic strictures.
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#14
hello, why cant it be an adenocarcinoma developing in a Barretts esophagus?
the patient has h/o chronic heartburn,is elderly, has s/o aspiration (pnemonia)
so all these point to some malignancy.
Isnt the first choice, then, endoscopy and biopsy?
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#15
I think clue word is dysphagia to solid and fliuds simultaneosly. With obstruction you wanna think of dyspahagia to first solids then later fluids. So solids and fluids simultaneosly makes you think of a motility problem first and these are achalasia, des, and scleroderms. Now since this patient has not had a Barium swallow first thing is BS, if BS comes back unresolved then go for Motility studies.
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#16
Also
BS gives you a road map of the esophagus. If you see any abnormalities or obstruction then go to endoscopy and biopsy. So BS in this case is easier, less invasive before jumping to endoscopy.
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