GI1 Case B Answers

A 26 yo immigrant from Venezuela presents to your GI clinic because his dentist was not able to "cure" his constant complaint of halitosis. In addition to halitosis, he's started to have a hard time swallowing solid foods and is most noticeable when he's eating his favorite marinated meat that his mom prepares. He complains of more frequent "heartburn" during meals and uncontrollable hiccuping without the ability to burp. He's come to you today because he believes whatever is going on is interfering with his ability to the best foodie he can be and has started to take away some of the joy he normally gets from eating food.

On esophageal manometry, you note abnormalities. On barium swallow, you see the following? What is your leading diagnosis?

Achalasia.

Name 4 different routes to the pathogenesis of this disease:
1. Incomplete relaxation of the LES
2. Destruction of Ganglion cells in the myenteric plexus
3. Dilatation of esophagus proximal smooth muscle contraction
4. Acquired cause is Chagas's Disease

Name 3 pharmacologic treatments to this disorder:
1. Long-acting Nitrates
2. Ca Channel Blockers
3. Botulinum Toxin Injection

What type of cancer is this patient at risk for? Use the following image to help you.

Squamous Cell Carcinoma of the Esophagus

Name three risk factors for this cancer:
1. Smoking (MCC-Most Common Cause)
2. Alcohol abutse, lye strictures (Substance)
3. Achalasia, Plummer-Vinson Syndrome (Mechanical)

Where do these cancers usually reside in the esophagus?

Middle Third

Name the etiology/implications of these clinical presentations
1. Dysphagia for liquids (Progressive disease. Initial presentation is usually dysphagia for solids)
2. Dry Cough/Hemoptysis (probable invasion of the trachea)
3. Hoarseness (probable invasion of the recurrent laryngeal)
4. Hypercalcemia (paraneoplastic syndrome from PTH production)

Histopathological Highlight from UTAS____________________________