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  #1  
Old 12-21-2011
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GIT Dysphagia to solids and liquids

A 54-year-old man with a history of 2 myocardial infarctions now complains of difficulty swallowing. He describes progressive dysphagia over the past 2 months that started with a little difficulty with low-fat cheese. He was trying to stick with his low carbohydrate and cardiac diet, but sometimes strayed. He noted that while out at restaurants he would initially experience the bread and steak “sticking” in the substernal area and it now involves all foods (even liquids). What is the obvious etiology of his complaints?
A) Esophageal Carcinoma
B) Distal Esophageal Ring
C) Esophageal Motility Disorder
D) Esophageal Web
E) Esophageal Stricture
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  #2  
Old 12-21-2011
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esophageal CA ..progressive dysphagia from solid to liquids
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  #3  
Old 12-21-2011
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C)Esophageal Motility Disorder
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  #4  
Old 12-21-2011
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the answer is given as esophageal motility disorder..however i feel it is carcinoma as the dysphagia is progressive from solids to liquids in carcinoma. I thought the dyshpagia in motility disorders is simultaneous for both solids and liquids?
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Old 12-21-2011
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Quote:
Originally Posted by sonu.agarwall View Post
the answer is given as esophageal motility disorder..however i feel it is carcinoma as the dysphagia is progressive from solids to liquids in carcinoma.i thought the dyshpagia in motility disorders is simaltaneous for both solids and liquids?
i think there are no risk factors for cancer in this patient, so we have to think something else...
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Old 12-22-2011
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Quote:
Originally Posted by drnirajmavani View Post
i think there are no risk factors for cancer in this patient, so we have to think something else...
And dont have weight loss
Ill think is B, but C could be the answer considering that cheese is a soft solid then meat and bread as strong solids then liquids... Is not quite the order of solids to liquids
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  #7  
Old 12-23-2011
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Default It's Ca

it's a
because the patient is old male
it's also safer for the patient to exclude ca first because it's course of the ca
motility disorder more common in female
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  #8  
Old 12-28-2011
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wouldn't the motility disorder give problems from younger age. and motility disorders which are mostly neurological usually have more difficulty swallowing liquids. and there is a clear cut progression from solid to liquids.
so i think Ca is more likely.
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Old 01-13-2012
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Cool hi

hi i am posting for the first time!!!i did step 1 with 229 before this i was a silent viewers!!!its clearly ca esophagous suggesting things are age h/o mi and transition from solids to liquids!!
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  #10  
Old 01-13-2012
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Default Esophageal Motility Disorder

Well, let's take the vignette from another approach >>

This patient experienced 2 MIs previously ,,

So as a complication of his MIs he developed ventricular aneurysms which

lead to pressure on the oesophagous So I guess the answer is

Esophageal Motility Disorder
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  #11  
Old 01-13-2012
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Quote:
Originally Posted by dr-ahmed View Post
Well, let's take the vignette from another approach >>

This patient experienced 2 MIs previously ,,

So as a complication of his MIs he developed ventricular aneurysms which

lead to pressure on the oesophagous So I guess the answer is

Esophageal Motility Disorder
should not it be atrial dilation which will impinge upon esophagus? in that case probable explanation would be LV systolic failure which might lead to LA enlargement ( i am not sure if it can happen without any valve lesion)...
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