GOGETA
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A 45-year-old male presents with the complaint of difficulty swallowing both liquids and solids, which was mild initially but has worsened gradually. He also complains of nocturnal cough, which disturbs his sleep as well as regurgitation of undigested food eaten several hours earlier. Physical examination is unrevealing. Barium studies are performed which shows dilated esophagus, loss of esophageal peristalsis, and smooth tapering of the distal esophagus. What will be the most appropriate next step in the management of this patient?
But Why?
I have in my head manometry but it says is wrong
Thanks
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| liliaeliz
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choice?
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| smalley
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esophagoscopy is the next step in pts presenting with dysphagia after barium to rule malignacy etc manometry may be after it to confirm diagnosis
Edited by smalley on 05/22/08 - 08:03 AM
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| Vietnamese
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He had achalasia. History and "smooth tapering" seem to be benign, then endoscopy is the next step to rule out malignance.
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| DrVirgo
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Anytime a patient presents with dysphagia, and GERD symptoms, the FIRST step is Barium (to get a map of the Esophagus) NEXT step is Endoscopy (to rule out cancer), and final step is Manometry.
-you have to do barium before scoping to get a map of the esophagus... incase there is a tumor or weakness in the esophageal wall, you don't want to perforate it with your scope... that would be disasterous.
-and you have to do endoscopy before manometry to rule out cancer.
-I hope it's clear... If you have anything else to add, please comment. 
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| smalley
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i agree with u dr virgo but in clear cut cases suggesting malignacy u can go directly with endoscopy
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| guangyu
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| DrVirgo
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Please refer to Kap Surgery notes... It says that Endoscopy and Biopsy are necessary to make the diagnosis, but these MUST be preceded with Barium to prevent inadvertent perforation.
Like I said in my last post, you NEED to get a road map of the esophagus incase there is an area of weakness due to the tumor, the last thing you want to do is cause a perforation with your scope!
Barium BEFORE Endoscopy.
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| angel23
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i agree with drVirgo
but in this case barium has already been done
so nxt step in management wud b endoscopy with biopsy to rule out cancer
cancer is the only diagnosis i think coz of long standing GERD...development of Barret's and so CA
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| peter90036
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DrVirgo already explained everything. i'd like to state my agreement with his management.
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| DrVirgo
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angel23 wrote:
i agree with drVirgo
but in this case barium has already been done
so nxt step in management wud b endoscopy with biopsy to rule out cancer
cancer is the only diagnosis i think coz of long standing GERD...development of Barret's and so CA
I agree with you too.
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| DrVirgo
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peter90036 wrote:DrVirgo already explained everything. i'd like to state my agreement with his management.
Correction: -her management.
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| peter90036
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 ... oops !
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| mildus
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nice expl., drVirgo
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