sunny2
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52 years old male patient by name of Tom Cruise comes to your office with progressive difficulty in swollowing both solids and liquids that means he is having problem swollowing meat and drinking coke which is bothering him too much, he also complains of occasional regurgitation of undigested food and a night time cough which disturbs his sleep so he doesn't wakes up fresh in the morning for work. Dr. John Trevolta did his physical examination and that was unremarkable. Barium study shows dilated esophagus and loss of esophageal perestaltic activity, there is a smooth tapering of esophagus. Which of the following is the most appropriate next step in management.
1. Esophageal manometry
2. Esophagoscopy
3. Esophageal pH monitoring
4. Botulinium Toxin ingestion
5. Pnumatic Dilation
6. Cricopharyngeal myotomy
7. Barium enema
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| frank100
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diagnosis: acalasia. barium study was already done, so best next step is treatment: pneumatic dilation (works in 80 to 85% of people)
i would choose (5)
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| guayoman
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Actually, the only diagnosis we can give as of now is esophageal obstruction. It could even be cancer ( possible by age group). If yoou do pneumatic dilatation on cancer youo are in trouble.
The answer is esophagoscopy.
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| guayoman
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Not manometry because it only confirms an obstruction.
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| frank100
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yup, you´re right.
scope is the answer
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| shumaila
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i think answer is manometry as u r suspecting achalasia but diagnosis is confirmed with manometry
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| study_ing
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"smooth tapering of esophagus"...what radiological significance duz that have?
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| study_ing
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Esophagram
weak nonpropulsive peristaltic waves below level of cricopharyngeus
will persist even after LES has been fixed
incomplete emptying of esophagus even in upright position
"rat tail" or "beak" appearance--gradual smooth tapering of distal esophagus
extends for 1 to 3 cm
Hurst Phenomenon--temporary transit through cardia provoked by hydrostatic pressure of barium column reaching above a critical level
great link for achalsia radiography http://www.med.wayne.edu/diagRadiology/TF/GI/GI09...
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| frank100
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manometry sounds better, it will rule out my big one (acalasia). if manometry isn´t ok, then scope. what do you think guys?
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| GDS2008
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The nextbset step should be upper GI endoscopy (option 2 is the answer) to r/o secondary achlasia or other causes of esophageal obstruction. It is only after endoscopy that one would proceed with either manometry or treatment (i.e. dilatation).
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| sunny2
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Yes , Esophagoscopy is the answer.
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| study_ing
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thanx sunny 2. ur questions are great
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| frank100
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good question!!! thanks
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