تصفح
دخول
تسجيل
نسيتها؟

Not able to swallow for 2 days


Not able to swallow for 2 days


حالة سريرية

الوصف الكامل Background
I got a call from ER last week on Friday with
52 year old man came with sensation of food got stuck in his esophagus for the last 2 days after he was eating stake . He has been trying to push it down with water or with pressing on his sterna notch without success. He has not been able to eat or drink of the last two days. Also for the last one day he has been getting intermittent sever epigastric pain that lasts for seconds without clear aggravating or relieving factors

What are the questions you like to ask?

المرجع

real life

ABIM's picture
by


do we have to refresh the image

ABIM's picture
ABIM


sorry the page

ABIM's picture
ABIM


Anybody there

ABIM's picture
ABIM


This is taking too long

ABIM's picture
ABIM


no u don't have to do that doctor Eye-wink

Dr.Striving's picture
Dr.Striving
بعد التخرج


ok I guess I will relax a little.. You know

ABIM's picture
ABIM


i wanna to ask u .. if this case happen before with this patient??

Dr.Striving's picture
Dr.Striving
بعد التخرج


شكى المريض من أعراض مرافقة
متل زلة نفس ،،حرقةفؤاد

willy_wonka's picture
willy_wonka
السنة الخامسة


His symptoms has been on and off for few years and for solids only.

ABIM's picture
ABIM


He gets heartburn also periodically and treats it with on demand PPI

ABIM's picture
ABIM


is there regugitation of food?
have this problem occured before?

nafartete's picture
nafartete
السنة السادسة


Nafartete
yes .. may be did not see above

ABIM's picture
ABIM


did he get better after taking PPI?

Dr.Striving's picture
Dr.Striving
بعد التخرج


كنتو قولو انو النقاش بلانكليزي , ماكنت استنيت النقاش اسبوع Sad

dr.muhanad.h


What did he do to relive his dysphagia??
Also does he complain of having smelly breath?

willy_wonka's picture
willy_wonka
السنة الخامسة


I m still waiting for couple more important questions

Quote:
كنتو قولو انو النقاش بلانكليزي , ماكنت استنيت النقاش اسبوع

Too bad ... YOu did not read the add and the content carefully..
you can still use Arabic my friend but as I said I will use English only

No smally breath
PPI helps the heartburn < but no dysphagia that happens every few months with sever attack but he has been able - so far- to get the food down finally with drinking but not this time

ABIM's picture
ABIM


i ll ask him about smoking , food , histoy family , medic history , and where is he from?

Tariq1987's picture
Tariq1987
بعد التخرج


wight loos??
melena??
vital signs??

abooofaroook
بعد التخرج

Quote:
He has not been able to eat or drink of the last two days

why?
because of bain (phobia) or the dysphagia?

i-Sun's picture
i-Sun
طبيب مقيم

Quote:
He gets heartburn also periodically and treats it with on demand PPI

since when??

did he complain of weight loss? anorexia? other systemic symptoms?

nafartete's picture
nafartete
السنة السادسة


was there losing weight or anorexia in the last 6 months?

drferas's picture
drferas
السنة السادسة


is there odynophagia?

Tariq1987's picture
Tariq1987
بعد التخرج


Every thing he tries to swallow comes back , even his saliva

No weight loss, no melena , no vomiting.

Other parts of H& P
No other GI symptoms
PMH none, PSH none, SH: he is a smoker, married, 3 kids (one of them was my patient before and had similar attack of dysphagia 2 year prior after she ingested a vitamin pill)
Allergies: none, Meds : none except pantoprazole as needed
ROS : negative for SOB , cough , angina pain, though he does feel sore through and feverish for 1 days and attribute that to Upper Respiratory tract infection.
O/E vital signs were stable afebrile normotensive , he appeared in distress and not able to swallow saliva
HEENT, Lungs, CVS, Abdomen, CNS, Extremities normal

ABIM's picture
ABIM


What do you think is the cause of the symptoms?
Do you like to do any investigations?

ABIM's picture
ABIM


egd

Tariq1987's picture
Tariq1987
بعد التخرج

now what shall we do?
ddx or investigations?
nafartete's picture
nafartete
السنة السادسة


لا أولاً بلعة الباريوم

Tariq1987's picture
Tariq1987
بعد التخرج


before you suggest the investigation I want to hear WHY ? what r u thinking of

ABIM's picture
ABIM


can i get a manometry for esophagus??

Dr.Striving's picture
Dr.Striving
بعد التخرج

Quote:
What do you think is the cause of the symptoms

i think that the patient have cancer

drferas's picture
drferas
السنة السادسة
ابق على تواصل مع حكيم!
Google+