Cases Flashcards
A patient presents with chest pain and difficulty swallowing.
What is the differential diagnosis?
What is the steps of testing
What is the recommended?
- Esophagitis (GERD)
- Coronary artery disease
- Esophageal spasm/ stricture/ or a tumor
The heart possibility is worrying, first image the heart. If that is okay.
Time for endoscopy:
-can dilate balloon to open a stricture
Treatment for esophagitis:
dietary changes, do not eat before bed,
use proton inhibitors: omeprozole
or H2 blocker (ranitidine)
What is Barrett Esophagus
- esophagus showing abnormal development
- like butterfly wings
-squamous epithelium is becoming columnar epithelium.
Increased incidence of adenocarcinoma (maybe barret increases the amount of columnar)
10% of GERD patient develop Barretts
10% of Barretts show dysplasia > adenocarcinoma
What is the difference between biliary colic and acute cholecistitis?
Biliary colic:
RUQ pain lasting less than 4 hours and follows meals
Stone is lodged in the cystic duct and stone falls back into the fundus and pain is relieved.
Acute Cholecistitis: inflammation of gallbladder.
- there is constant pain going on for longer than 4 hours and radiates to shoulder or back
- there is nausea/vomiting
- a positive murphy sign
- there are signs of inflammation with elevated WBCs.
Describe the progession of acute cholecystitis, beginning with mucosal phospholipases which hydrolyze luminal lecithins to toxic lysolecithins.
- These toxic lysolecithins damage the mucosa of the gallbladder.
- The glycoprotein mucus protection is compromised
- The mucosa is then damaged by salts.
- The damage initiates prostaglandin release in mucosa which causes inflammation in gallbladder wall.
- This inflamattion leads to inability for gallbladder to move properly (chronic inflammation will lead to thickening of bladder wall)
- The gallbladder stasis which is the key player allows for gall stone formation.
7 Stone gets lodged in cystic duct.
