kpmle2
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74-year old African-American male recently noticed difficulty in swallowing pills and solid foods. The symptoms had started to worsen over the past 4-week period. He was alarmed and decided to consult his primary care physician. In taking a history it was determined that the patient thought that although his problem with solids had progressed rapidly, he had little or no problem with liquids. He had a long-standing history of gastroesophageal reflux disease (GERD) and although omeprazole had been prescribed to treat it, he admitted to not using it regularly. He said that this was because he depended on Medicare D 2006, which did not cover the price of drugs. At the present time he did not smoke, but he had started smoking at the age of 14 and quit some 10 years ago. He drank beer on social occasions. Which of the following conditions is the most likely diagnosis?
A: Diffuse esophageal spasm
B: Achalasia
C: Esophageal stricture
D: Esophageal ring (Schatzki ring)
E: Esophageal carcinoma
F: Zenker's diverticulum
G: Esophageal varices
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| donjuan
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E
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| hanialkhadher
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E 
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| dr.wad
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E
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| elitoki
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E
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| Ivonne
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(E)
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| mjl1717
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can anyone explain there answer in CLEAR english?
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| sprint123
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Why can't it be esophageal stricture? Any suggestions?...Though smoking stands in for carcinoma, long standing history of GERD can predispose to stricture formation which has similar kind of presentation.
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| Justice
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E: Esophageal carcinoma
sprint123 wrote:
Why can't it be esophageal stricture? Any suggestions?...Though smoking stands in for carcinoma, long standing history of GERD can predispose to stricture formation which has similar kind of presentation.
For strictures, damage to mucous membrane is not enough but that would be the only and maximal damage in esophagus due to GERD... Strictures usually follow acid/alkali ingestion, not tobaco/beer/gastric acid...
And I am sure that GERD has nothing to do with current symptoms, but history of smoking + alcohol constitute necessary etiology
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| Miradautas Vras
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Carcinoma would be more plausible answer given specific history of food ingestion difficulty and long smoking history. And even if a stricture is there it's mostly carcinoma stricture .
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| doc_clotaire
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Aprox . 50 yeears of smoking + Alcohol + long standing GERD = Esofageal Cancer
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| DrVirgo
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It's Eso. Cancer.
Older, smoker, drinker, untreated long standing GERD, and progressive dysphasia (although his dysphagia has not progressed to liquids, it has progressed quickly and he will probably have dysphagia for liquids in time if the obstruction gets big enough)...
Smoking leads to Squamous Cell Carcinoma of the Eso.
GERD leads to Barrets which then can lead to Adenocarcinoma of the Eso.
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| kpmle2
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yes the answer is E: Esophageal carcinoma
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| dr in trouble
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E
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