Approach to Dysphagia: Esophageal Cancer & Achalasia Cases
This presentation covers the diagnostic approach and management strategies for dysphagia in a 65-year-old patient presenting with symptoms such as odynophagia, cough, hoarseness, and lymphadenopathy. It discusses the use of CBC, CXR, ECG, upper GI endoscopy, CT, and biopsy in assessing the location, size, and obstruction in esophageal cancer. Treatment options include nutritional support, endoscopic dilatation, stenting, TPN, gastrostomy tube, chemo, radiotherapy, and surgical interventions like esophagectomy. A similar approach is depicted for a 30-year-old patient with dysphagia. Images and descriptions accompany each step of the diagnostic and management process.
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Presentation Transcript
Case1 :Esophageal Cancer Diagnosis Management Case2 : Achalasia Diagnosis Management Case3 : GERD Diagnosis Management
65 years old complaining of dysphagia. How will approach him?
onset duration site progression associated symptoms Odynophagia Cough hoarseness
CBC CXR ECG
Location Size Obstructing? Biopsy
Location Size Obstructing?
Conservative Surgical
Adenocarcinoma Squamous carcinoma
Nutritional status support Endoscopic dilatation &stenting TPN Gastrostomy tube Chemo radiotherapy
Esophagectomy: Trans hiatal esophagectomy Transthoracic esophagectomy
30 years old complaining of dysphagia. How will approach him?
Onset Duration Site Progression Associated symptoms
Birds beak or Rats tail Obstructing? Regular stricture edges
Manometry study: High LES pressure Aperstalises Fail of LES relaxation
Conservative Surgical
Pneumatic dilatation Calcium channel blockers Botulinum toxin injection
30 years old complaining of heartburn and regurgitations. How will approach him?
Onset Duration Associated symptoms Has he treated before Responding to medications
Barium swallow: Reflux of the material to the esophagus
Ambulatory 24 h PH monitoring Demester score >14.7
Conservative Surgical
Laparoscopy or laparotomy and Nissen fundoplication
Esophagitis Peptic stricture Barrit esophagus :The most serious one as it consider as a pre malignancy (intestinal metaplasia in the lower esophagus).
