GPA - Dysphagia

Question 1

DDX Dysphagia
75 yo: dysphagia solids to liquids
Alcoholic, heavy smoker
wt loss 7 kg in 4 months

Answer 1

Cancer:  Esophageal
Achalasia: motor of exophagus is messed up
Systemic sclerosis
Esophageal Stricture
Lung cancer

Question 2

Workup - Dysphagia
75 yo: dysphagia solids to liquids
Alcoholic, heavy smoker
wt loss 7 kg in 4 months

Answer 2

CBC
CXR
Upper endoscopy
Barium swallow
CT-chest

Question 3

DDX - Dysphagia
x 2 weeks
 mouth and throat pain.
fatigue
craving for ice and clay

Answer 3

Plummer vinsion syndrome: long term iron deficiency, anemia ex, esophageal webs, fatigue
Esophageal cancer 
Esophagitis
Achalasia
Systemic sclerosis

Question 4

Workup - Dysphagia
x 2 weeks
 mouth and throat pain.
fatigue
craving for ice and clay

Answer 4

CBC: anemia
Upper endoscopy, barium swallow
Ferritin**
TBIC**
Serum iron

Question 5

DDX - Dysphagia
Progressive over 1 year,
inability to swallow solids and liquids
regurgitation of undigested foods

Answer 5

Achalasia
Plummer-Vinsion syndrome
Esophageal cancer
Esophageal 
Esophagitis

Zenker diverticulum
mitral valve stenosis: compression from enlarged left ventricle

Question 6

Workup - Dysphagia
Progressive over 1 year,
inability to swallow solids and liquids
regurgitation of undigested foods

Answer 6

CXR
neck Xray
Endoscopy, barium swallow: CA,Zenker
Esophageal manometry: achalasia

Question 7

DDX - Dysphagia
pain on swallowing solids and liquids
Oral thrush

Answer 7

Esophagitis: HSV,
Systemic sclerosis
GERD
Esophageal stricture
Zenker diverticulum

Question 8

Workup - Dysphagia
pain on swallowing solids and liquids
Oral thrush

Answer 8

Endoscopy: gerd
Barium swallow: zenker, striture
CBC
HIV antibody test, CD4 count

Question 9

Key PE for dysphagia

Answer 9

Head and neck exam,
heart and lung, abdominal, skin
Look for scleroderma (CREST)