DysphageaDyspnea.txt

Dysphagia with solid or liquid. Chest pain that radiates to arm and jaw (mimics angina). Nitroglycerine (NO) relieves.

Treatment Ca2+ channel blockers, Nitrates, Myotomy (cut out distal esophagus)

Diffuse Esophageal Spasm (mechanical or motor)

Dysphagia with solid or liquid. Chest pain. Not relieved by NO. Bird's beak X-ray.

Treatment Botox, Nitrates, Dilation, Myotomy

Achalasia (mechanical or motor)

Dysphagia progresses from solid to liquid over months. Intermittent pain in chest or back. Weight loss. Coughing up blood. Laryngeal nerve palsy (hoarseness).

Treatment Surgery, Chemotherapy, Radiation, Laser ablation (pall), Dilation with stent (pall), feeding tube (pall)

Esophageal Cancer (mechanical or motor)

Dysphagia with solid food only. Regurgitation. Long history of GERD. Shatzki's ring. Intermittent dysphagia but slowly progressive.

Dilation with ballon (not stent)

Esophageal stricture (mechanical or motor)

Orthopenia

PND

Sudden onset of SOB. Hemodynamic instability. Mediastinal shift or tracheal deviation. Tympanic percussion. Quite breath sounds.

Sudden onset of SOB. Hemoptosis, Deep Vein Thrombosis (DVT), Tachycardia. Recent surgery (5-7 days ago)

How is treatment different for Pneumothorax v. PE?

Cough, wheeze, chest pain, history of smoking, Hemoptosis, Weight loss

Cough, slow progressive dyspnea, dyspnea on exertion, history of smoking

What does chest x-ray look like for the following (lung cancer, COPD, Pneumothorax, PE)

Resonance percussion of lungs

Tympanic Percussion

Dull percussion

Hyperesonance percussion

Orthopenia, PND, exertion or lying down can aggravate it dyspnea may be progressive or sudden