00:01
Let's move on to our next case.
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We have 55-year-old man who presents to clinic complaining of several months of difficulty swallowing.
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He notes mild chest discomfort immediately after swallowing.
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He sometimes regurgitates undigested food and complains of bad breath.
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He has lost 3 kg unintentionally.
00:19
He does not smoke or drink alcohol, and denies any symptoms of acid reflux.
00:24
On exam, vitals are normal. His abdominal exam and oropharyngeal exam are both unremarkable.
00:32
What is the best diagnostic step to confirm the diagnosis here?
So let's go through some key features.
00:38
He has chronic dysphagia, he has regurgitation and halitosis or bad breath, and a pretty normal physical exam.
00:49
So let's talk a bit about esophageal diverticula.
00:52
Esophageal diverticula can form due to muscular weakness in the esophageal wall
that usually results from an underlying motility disorder.
01:00
So the most common type here is called a Zenker diverticulum.
01:05
Over here on the right you can see in our diagram that with weakness in the esophageal wall, anti-pressure
eventually there's an outpouching that forms through the cricopharyngeal muscle in the upper third of the esophagus.
01:17
This outpouching is called the Zenker's diverticulum.
01:21
Patients may present with dysphagia, halitosis, they may have regurgitation of undigested food, chest pain, and chronic cough.
01:30
The diagnosis is made by doing a barium swallow and treatment is with a myotomy to relieve the high pressure
and to correct the underlying motility disorder.
01:43
So now let's return to our case.
01:45
We have a 55-year-old man with chronic dysphagia, frequent regurgitation and halitosis, and a pretty normal physical exam.
01:53
So all of these thing should lead you to think about features of his esophageal diverticula
and know that the best diagnostic step is a barium swallow.