DYSPHAGIA

DYSPHAGIA

Case study
* A 51 yr.old female presented with a hx of dysphagia that has been progressively worsening for months. Initially dysphagia was for solids only but more recently it is for both solids and liquids.
* Which of the following studies will most likely establish the diagnosis
* EGD
* Barium swallow
* CT
* manometry
Case study
* A 52 year-old male executive c/o intermittent dysphagia which began 2 years ago. When he is eating, he has episodes of the sudden sensation of food sticking in his throat after he swallows, lower chest discomfortand hypersalivation. On two occassions the discomfort has caused him to regurgitate undigested food. There is now wt loss.Physical exam is normal
* The most likely diagnosis is
* Achalasia
* Diffuse esophageal spasm
* Esophageal ring
* Peptic stricture
* Adenocarcinoma

INTRODUCTION
* Dysphagia—difficulty with swallowing—is a common condition, reported by 5–8% of the general population aged over 50 years, and by 16% of the elderly.
* Dysphagia, particularly oropharyngeal dysphagia, is even more common in the chronic-care setting; up to 60% of nursing-home occupants have feeding difficulties that include dysphagia.

Esophageal Anatomy
SWALLOWING
REVIEW
Swallowing Stages
* Oral
* Pharyngeal
* Esophageal
HISTORY
Where is the site of bolus hold-up?
OROPHARYNGEAL VS ESOPHAGEAL
Etiology of oropharyngeal dysphagia.
ESOPHAGEAL
* Differntiation mechanical vs motility disorder?
Is the dysphagia for solids or liquids
Motility- features
How long has dysphagia been present? Is it intermittent? Is it progressive?
Examination of the patient with dysphagia
Investigation of esophageal dysphagia
NO DYSPHAGIA
INTERMITTENT DYSPHAGIA FOR SOLIDS
DYSPHAGIA WITH LONG HX OF GERD
Bulge in the left side of the neck while eating
DYSPHAGIA FOR SOLIDS AND LIQUIDS WITH WT LOSS
DYSPHAGIA FOR SOLIDS AND LIQUIDS
INTERMITTENT DYSPHAGIA FOR SOLIDS AND LIQUIDS
IRON DEFIIENCY ANEMIA

DYSPHAGIA.ppt

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Conditions of the Vulva and Vagina

Conditions of the Vulva and Vagina
By:Marjorie Greenfield MD
Department of Reproductive Biology
a.k.a
Obstetrics and Gynecology

Learning Objectives
* Know surface anatomy of vulva and vagina
* Name and describe common vulvar conditions—skin, subcut, glandular
* Understand the concept of the vagina as an ecosystem influenced by hormones
* Use the ecosystem model to describe four types of vaginitis

Vaginal structure
The vaginal wall
Vaginal function: sexual
Vaginal function: reproductive
Benign conditions of the vagina
The vagina as ecosystem
Where are the bacteria?
Lactobacilli are the good guys because they make acids
The vaginal ecosystem: estrogen present
The vaginal ecosystem
Vaginitis: Why do you need to know?
Common causes of vaginal symptoms
Bacterial vaginosis: a synergistic bacterial infection
Amsel’s criteria for BV:
Repercussions of BV
Bacterial vaginosis:
Is BV a sexually transmitted infection?
Candida vulvovaginitis
Candida likes an estrogenized environment
Asymptomatic yeast carriage
What determines symptomatic candida vulvovaginitis?
Microscopic diagnosis
Wet prep
KOH prep
Role of culture in the diagnosis
Trichomonas vaginitis
Comparative exudates
Atrophic vaginitis
Approach to the Evaluation of Vaginitis
Evaluation of Vaginitis Symptoms
The Vulva
Vulvar function
Vulvar Tissue Types
Vulvar conditions
Skin processes Vulvar dermatoses
Vulvar dystrophies:
Non-neoplastic epithelial disorders
Lichen sclerosis
child
Squamous cell hyperplasia
Other skin processes
* Infections—mostly STDs
* Neoplasms
Subcutaneous processes
* Inclusion cysts
* Fibroma, lipoma, hernia, female hydrocele
* Breast tissue
endometriosis
lipoma
Gland processes
* Skenitis
* Bartholin gland cyst or abscess
Summary
Pathology correlation
Lichen sclerosus
Normal skin
Squamous cell hyperplasia
Normal skin

Conditions of the Vulva and Vagina.ppt

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Sexually Related Diseases/Problems in Women

Sexually Related Diseases/Problems in Women: Vaginitis, PID, Unintended Pregnancy
By:Sarah Guerry, MD
Medical Director, LAC STDP
UCLA

Vaginitis:
What is it?
* Clinical syndrome caused by inflammation/infection of the vagina
* Characterized by abnormal vaginal discharge
* Sometimes caused by an STD

Vaginitis: Who Cares?
Vaginitis Etiologies
Differential diagnosis:
* Irritant Dermatitis
* Foreign body
* HSV
* MCP from GC or CT
* Atrophic vaginitis
* UTI
* Desquamative vaginitis

Vaginitis Epidemiology
* Most common reason for doctors visit

Microbiology of the Vagina
Normal Vaginal Physiology
Factors Adversely Affecting Normal Vaginal Flora
* Douching
* Antibiotic and antifungal therapy
* Hormonal changes: pregnancy, OCs
* Spermicides, lubricant
* Foreign bodies: tampons, IUD, diaphragm
* Intercourse, semen
* Menses


Effects of Estrogen Status on Vaginal Microflora
Infection as a Cause of Vulvovaginitis Across the Lifespan
Vaginitis: Clinical Presentation
* Abnormal vaginal discharge
* Vulvar itch
* Odor
* Discomfort
* Burning with urination
* Painful intercourse

Clinical Evaluation of Vaginitis Physical Exam
* Characteristics of vaginal discharge
* Appearance of the vulva
* Appearance of vaginal mucosa
* Appearance of cervix
* Abdominal/bimanual exam

Diagnostic Evaluation of Vaginitis
* Vaginal pH
* Whiff test (amine test)
* Microscopy
* Chlamydia and GC tests

Vaginal pH Measurement
Bacterial Vaginosis A sexually-associated disease
Bacterial Vaginosis
Clinical Presentation of BV
BV: Diagnostic Criteria
BV: Treatment
BV: Complications
BV: Complications in Pregnancy
BV: Screening in Pregnancy
BV: Treatment Criteria
BV: Recurrent Infection
What’s Wrong with Douching?
Vulvovaginal Candidiasis (VVC)
VVC: Risk Factors
VVC: Clinical Manifestations
Yeast Colonization Study
Most Common Misdiagnoses among Women Reported to Have Recurrent VVC
Diagnosis of VVC
VVC: Diagnosis
Uncomplicated VVC: OTC Treatment
Topical Therapies:
Oral Therapy:
Trichomoniasis
Trichomonas: A Pathogen Over Lifetime
Trichomoniasis Clinical Presentation
Trichomoniasis: Diagnosis in Women
Trichomoniasis: Diagnosis in Men
Trichomonas vaginalis
Seattle STD/HIV Prevention Training Center
Trichomoniasis: Treatment
PID Clinical Presentation
Reproductive Anatomy & Spread of Infections
Pelvic Inflammatory Disease (PID):Magnitude of the Problem
PID Diagnostic Considerations
CDC Diagnostic Criteria for PID and much more

Sexually Related Diseases/Problems in Women.ppt

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