Diagnosis of Esophagus diseases
Esophagus diseases Diagnosis: Book Excerpts
Diagnostic Tests for Esophagus diseases: Online Medical Books
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REGURGITATION, ESOPHAGEAL:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there dysphagia? The presence of difficulty swallowing should suggest carcinoma of the esophagus, esophageal strictures, esophageal diverticulum, achalasia, aortic aneurysm, and other mediastinal masses.
- Is there significant weight loss? The presence of significant weight loss suggests carcinoma of the esophagus and esophageal stricture. It is also found in the late stages of achalasia.
- Is there heartburn? Several of the conditions associated with esophageal regurgitation may be accompanied by heartburn, but reflux esophagitis and gastric ulcer are the most common.
DIAGNOSTIC WORKUP
Most disorders will be diagnosed by an upper GI series with an esophagogram and esophagoscopy with a biopsy. A Bernstein test, esophageal pH monitoring, and esophageal manometry may be useful in diagnosing reflux esophagitis. A CBC, serum iron, ferritin, and iron-binding capacity will help diagnose Plummer-Vinson syndrome. An ANA titer and skin biopsy will help diagnose scleroderma. A CT scan of the mediastinum will help diagnose most mediastinal masses, and angiography will be useful in diagnosing an aortic aneurysm.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Tracheoesophageal fistula and esophageal atresia:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Respiratory distress and drooling in a neonate suggest tracheoesophageal fistula and esophageal atresia. The following procedures confirm the diagnosis:
❑ A size 10 or 12 French catheter passed through the nose meets an obstruction (esophageal atresia) approximately 4" to 5" (10 to 12.5 cm) distal from the nostrils. Aspirate of gastric contents is less acidic than normal.
❑ Chest X-ray demonstrates the position of the catheter and can also show a dilated, air-filled upper esophageal pouch, pneumonia in the right upper lobe, or bilateral pneumonitis. Both pneumonia and pneumonitis suggest aspiration.
❑ Abdominal X-ray shows gas in the bowel in a distal fistula (type C) but none in a proximal fistula (type B) or in atresia without fistula (type A).
❑ Cinefluorography allows visualization on a fluoroscopic screen. After a size 10 or 12 French catheter is passed through the patient’s nostril into the esophagus, a small amount of contrast medium is instilled to define the tip of the upper pouch and to differentiate between overflow aspiration from a blind end (atresia) and aspiration due to passage of liquid through a tracheoesophageal fistula.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Esophageal diverticula:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
CONFIRMING DIAGNOSIS X-rays taken following a barium swallow usually confirm the diagnosis by showing characteristic outpouching.
Esophagoscopy can rule out another lesion; however, the procedure risks rupturing the diverticulum by passing the scope into it rather than into the lumen of the esophagus, a special danger with Zenker’s diverticulum.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Esophageal cancer:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
X-rays of the esophagus, with barium swallow and motility studies, reveal structural and filling defects and reduced peristalsis.
CONFIRMING DIAGNOSIS Endoscopic examination of the esophagus (esophagogastroduodenoscopy), punch and brush biopsies, and exfoliative cytologic tests confirm esophageal tumors. Usually, magnetic resonance imagining of the chest and thoracic computed tomography are helpful in determining disease staging. Positron emission tomography is useful in determining disease staging and whether surgery is possible.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Corrosive esophagitis and stricture:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
CONFIRMING DIAGNOSIS A history of chemical ingestion and physical examination revealing oropharyngeal burns (including white membranes and edema of the soft palate and uvula) usually confirm the diagnosis.
The type and amount of the chemical ingested must be identified; this may be done by examining the container of the ingested material or by calling the poison control center.
Two procedures are helpful in evaluating the severity of the injury:
❑ Endoscopy (in the first 24 hours after ingestion) delineates the extent and location of the esophageal injury and assesses the depth of the burn. This procedure may also be performed a week after ingestion to assess stricture development.
❑ Barium swallow (1 week after ingestion and every 3 weeks thereafter) may identify segmental spasm or fistula, but doesn’t always show mucosal injury.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Esophageal diverticula:
Diagnosis
(Handbook of Diseases)
A barium esophagogram usually confirms the diagnosis by showing characteristic outpouching. Esophagoscopy isn’t performed because the scope may be passed into the diverticulum and can cause a rupture.
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Source: Handbook of Diseases, 2003
Esophageal cancer:
Diagnosis
(Handbook of Diseases)
X-rays of the esophagus, with barium swallow and motility studies, reveal structural and filling defects and reduced peristalsis. Endoscopic examination of the esophagus, punch and brush biopsies, and an exfoliative cytologic tests confirm esophageal tumors.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Esophagitis, corrosive (caustic):
Diagnosis
(Handbook of Diseases)
A history of chemical ingestion and physical examination that reveals oropharyngeal burns (including white membranes and edema of the soft palate and uvula) usually confirm the diagnosis. The type and amount of the chemical ingested must be identified; sometimes this can be done by examining empty containers of the ingested material or by calling the poison control center.
Endoscopy (in the first 24 hours after ingestion) delineates the extent and location of the esophageal injury and assesses the depth of the burn. This procedure may also be performed a week after ingestion to assess stricture development.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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