sheena2005
Forum Elite
Topics: 26
Posts: 257
|
what is the best test to make the diagnoses of achalasia?
|
| sheeezooo
Forum Guru
Topics: 30
Posts: 343
|
esophageal manometery
___________________
if u hold up your head with a smile on your face and are truely thankful,u are blessed because the majority can, but most do not..
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
best test (most accurate)? : manometry
best test (when high clinical suspicion, and nothing else), barium swallow
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
thanks people. but how can barium swallow be best because tumour can present same picture.
|
| study_ing
Forum Fanatic
Topics: 180
Posts: 2,509
|
initial test for patient with dysphagia--barium swallow..
rule out eg zencker's diverticulum ( where esophagoscopy is contraindicated)
esophagoscope to rule out cancer as a cause of symptoms.
DIAGNOSTIC test for achalasia = manometry
Edited by study_ing on 08/30/06 - 01:51 PM
___________________
If you yourself are at peace, then there is at least some peace in the world.
|
| Isther
Forum Guru
Topics: 39
Posts: 744
|
I think that the guidelines are based on symptoms, not in the definitive diagnosis. The gold standard for achalasia is indeed manometry, but the patient comes with pain or dysphagia and other tests like endoscopy and barium swallow should be done first to rule out malignancy or other something else.
___________________
Useful information for USMLE and the residency matching process at http://www.usmlematch.com
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
sheezooo, you didnīt write down anything about the differential diagnosis, this wil lead to a different answer...
depends on the clinical scenario though...thatīs the answer, so post a case and then the answer will change.
and NO, the best initial test is almost never endoscopy. e.g: if there are signs of obstruction then you scope because you have a high suspicion of a mass there, but a tumor can still have no signs of obstruction, so itīll be very difficult to diagnose acalasia with an endoscope...but as I just said, it depend on the presentation.
"endoscopy first" is not a rule, never, not a rule.
another example: HIV (+) WITH DYSPHAGIA. whatīs the best next step: a trial with fluconazole. SO can you see, scope is nit the best next step here...
YOUR QUESTION WAS SIMPLE: WHATīS THE BEST STEP TO MAKE THE DIAGNOSIS OF ACHALASIA. SO MY ANSWER IS AS SIMPLE AS THE QUESTION. but if you add, tumors in the differential, OF COURSE THE ANSWER IS GOING TO BE DIFFERENT.
YOU ALREADY MENTIONED THE DIGNOSIS IN YOUR QUESTION: SO WHY BOTHER YOURSELF WITH THE DIFFERENTIAL...
|
| sheeezooo
Forum Guru
Topics: 30
Posts: 343
|
frank
i think sheena write the question..
i write the wrong ans...
___________________
if u hold up your head with a smile on your face and are truely thankful,u are blessed because the majority can, but most do not..
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
SORRY SHEEEZOOO!!!!!! from the bottom of my heart
|
| sheeezooo
Forum Guru
Topics: 30
Posts: 343
|
thats ok..
___________________
if u hold up your head with a smile on your face and are truely thankful,u are blessed because the majority can, but most do not..
|
| Isther
Forum Guru
Topics: 39
Posts: 744
|
Sheeezooo... I still think that you wrote the correct answer...
I know that the Q lacks a lot of info, but going straightforward... what is the best test to make the diagnoses of achalasia? the gold standard for achalasia is indeed manometry...
___________________
Useful information for USMLE and the residency matching process at http://www.usmlematch.com
|
| Isther
Forum Guru
Topics: 39
Posts: 744
|
So sheena2005... what is the answer??
___________________
Useful information for USMLE and the residency matching process at http://www.usmlematch.com
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
thanks frank. that was a good explanation. for eg. if they give us a question that a patient comes in with dysphagia to both solids and liquids , for almost a year, there is no history of weight loss, and no progression of synptoms. u order a barium swallow, and it shows narrowing of esophagus at the lower end, what is the next best test in evaluation?
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
and in the above question if u put in presence of arthalgias and raynoun'ds phenomenon and on barium study u find dilation of esophagus?then wahat's the best diagnostic test
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
yeah manometry is the best diagnostic test for achalasia.
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
barium is not the best but it's the initial test for achalasia
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
barium is not the best but it's the initial test for achalasia
|
| Isther
Forum Guru
Topics: 39
Posts: 744
|
Kaplan's teacher Conrad Fischer has a very nice way to put this dilema... The answer is not what you think but what they are really asking... the best next step is not always the first next step.
___________________
Useful information for USMLE and the residency matching process at http://www.usmlematch.com
|
| sheeezooo
Forum Guru
Topics: 30
Posts: 343
|
thats what my mind was remindin me from conard fischers lecture..
___________________
if u hold up your head with a smile on your face and are truely thankful,u are blessed because the majority can, but most do not..
|
|
| |
| | | | | | | | | | | | | | | | | | | |
Similar forum topics