usmlebuzz
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A 62-year-old African-American man reports progressive dysphagia that started three months ago with difficulty swallowing meat, and progressed to inability to swallow other solid foods, then soft foods and now liquids. He has lost over 25 lbs. during that time. He has a history of heavy smoking and drinking.
what is diagnosis?
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| Ouli Maty
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Esophageal cancer.
He has a risk factor :smoking and presents a chronic progressive dysphasia and weight loss.
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deep breathing...
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| usmlebuzz
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 correct
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| oddissy4u
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when does difficulty in taking liquids appear before solid s?
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| Ouli Maty
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Achalasia or the equivalent of Hirschsprung in the esophagus gives paradoxical dysphasia. Related to failure of the migration of neural crest cells to form the intrinsic innervation. Association of stenosis and dilatation : abnormal peristalsis.
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deep breathing...
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| alice8
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also in globus histericus
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Dream on 'til your dream comes true.
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| oddissy4u
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thts right.
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| Idiopathic
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remember, dysphagia for solids is always either muscular or neural in origin (achalasia) and dysphagia for both is obstruction (CA)
Q: which category does esophageal web from Plummer-Vinson fall into?
Q: how do you develop achalasia? (i.e. not congenital)
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| Ouli Maty
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Plummer-Vinson associates dysphagia, esophageal web and sideropenic anemia. The esophageal ring or web can cause intermitent or progressive solide dysphagia but mean complications are carcinoma and bleeding during endoscopic procedures.
Achalasia , involve increase in lower esophageal sphincter ( LES) tone and absence or decrease in esophageal peristaltis. It does result from inervation problemes but the cause of that is basically unknown :?: .
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deep breathing...
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| Idiopathic
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What I was looking for is:
a) The esophageal webs from Plummer-Vinson create an obstruction, and so there is dysphagia for solids and liquids.
b) Chagas disease from T. cruzi can cause acquired achalasia.
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| Idiopathic
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How about this one:
a) what is the MCC of Boerhaave's syndrome?
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| meg
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Bulemia
Also Alcoholic retching
Esophageal tears, air in mediastinum, with Hamman's crunch on auscultation. X ray widening of mediastinum.
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| Ouli Maty
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Kaplan's advice is to avoid answers with always and never.
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deep breathing...
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| Ouli Maty
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MCC what does it mean? :?:
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deep breathing...
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| meg
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Most common cause
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| Ouli Maty
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Thank you Meg.
In that case shouldn't alcohol come first .
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deep breathing...
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| meg
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yes you are right
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| mjl1717
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is that behavioral science?
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Smell the coffee! "Is That an Osler move??"
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| asmi
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but good discussion 
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| Idiopathic
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MCC of Boerhaave's syndrome is iatrogenic. Physician-induced due to endoscopy...I was surprised.
Mallory-Weiss tears are due to retching from bulimia.
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| Ouli Maty
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What are your source, please?
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| Idiopathic
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Ed Goljan, MD.
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