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Old 05-19-2013
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Default gastroenterology q1

A 47-year-old man is evaluated in the emergency department for chest pain that developed at a restaurant after swallowing a piece of steak. He reports intermittent episodes of meat getting stuck in his lower chest over the past 3 years, but none as severe as this event. He denies food regurgitation outside of these episodes or heartburn symptoms. He is able to swallow liquids without difficulty and has not had any weight loss. Which of the following is the most likely diagnosis?


A. Achalasia
B. Adenocarcinoma of the esophagus
C. Esophageal diverticula
D. Plummer-Vinson syndrome
E. Schatzkiís ring
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Old 05-19-2013
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Probably E.
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Old 05-19-2013
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Quote:
Originally Posted by asad8723 View Post
Probably E.
The answer is E. Schatzkiís ring

Intermittent solid food dysphagia is a classic symptom in Schatzkiís ring in which a distal esophageal ring occurs at the squamocolumnar mucosal junction. The origin of these rings is unknown, and smaller rings with a lumen of greater than 13 mm are common in the general population (up to 15%). When the lumen is less than 13 mm, dysphagia may occur. Schatzkiís rings typically occur in persons older than 40 years and often cause ďsteakhouse syndromeĒ from meat getting stuck at the ring. The rings are easily treated with dilation. Plummer-Vinson syndrome also includes esophageal rings, but typically the rings occur in the proximal esophagus, are associated with iron-deficiency anemia, and occur in middle-aged women. Achalasia involves both solid and liquid dysphagia often with regurgitation. Adenocarcinoma often includes solid and liquid dysphagia at later stages. Most esophageal diverticulae are asymptomatic
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Old 05-19-2013
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