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Postprandial emesis suggests lower esophageal disease.
- Pain, Emesis, Weight Loss - Think
On Exam:
- Can look for palpable masses/lymph nodes
- Succussion Splash- Sloshing sound heard on auscultation of stomach when pt. is rocked back and forth at the hips- often suggests gastric outlet obstruction or gastroparesis. One small study found ~1/3 of pts. with GOO to have + succussion splash.
Posted 01/04/17 11:09:39 AM by Adam Faye
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UGI Series: Drink barium contrast and multiple radiographs taken to see how contrast moves through esophagus and stomach
Endoscopy
- Carcinomas - Difficult to pass endoscope across
- Achalasia - Easy to push through with endoscope
Posted 01/04/17 11:14:18 AM by Adam Faye
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Short-Segment Barrett's:
Posted 01/04/17 11:21:24 AM by Adam Faye
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Esophageal Carcinoma: Two main subtypes of esophageal carcinoma
Squamous Cell Carcinoma (precursor: squamous dysplasia)
- 90% of cases world-wide
- Predominant type in Asia, South America, Africa
- Risk factors: Tobacco, Alcohol
- Location: Proximal – middle esophagus
Adenocarcinoma (precursor: Barrett’s esophagus)
- Increasing prevalence in North America, Europe
- Risk factors: GERD, obesity, tobacco
- Location: Distal esophagus
Posted 01/04/17 11:23:17 AM by Adam Faye
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Esophageal SCC Treatment: Standard is concurrent radiation + chemotherapy
Radiation
Chemotherapy
- No standard regimen (typically FU + cisplatin v paclitaxel + carboplatin)
Palliation
- Radiation v stents for dysphagia
Posted 01/04/17 11:25:25 AM by Adam Faye