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Diagnostic Dilemma: GI Disease

Diagnostic Dilemma: GI Disease

Test your diagnostic skills with the following endoscopic quiz.

This 62-year-old woman has a long history of dysphagia. She describes difficulty with solids and liquids. There is a history of weight loss amounting to 10 pounds over the last 6 months. She has been treated for presumed acid reflux in the past without response. Her swallowing difficulty has steadily increased over the last year.

Her past history is positive for hypertension on medical therapy. There is no history of smoking, and she consumes alcohol rarely. Family history is positive for lung cancer.

Physical examination is unremarkable. Laboratory evaluation is significant for normal CBC and chemistries.

The patient is referred for evaluation of this chronic progressive dysphagia. Upper gastrointestinal endoscopy is performed. The photograph is taken in the esophagus.

1) The endoscopic photograph demonstrates:
a) Ulcerative esophagitis
b) A Hiatal hernia
c) A Mallory Weiss tear
d) A dilated esophagus
e) large mass

2) The differential diagnosis includes:
a) Gastroesophageal acid reflux
b) Scleroderma
c) Achalasia
d) Esophageal cancer
e) All of the above

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