{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 1, Ep 1 of 3: Dysphagia: The Algorithm","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/6a5cd64e\"></iframe>","width":"100%","height":180,"duration":761,"description":"Dysphagia is the symptom that anchors the esophagus chapter, and the\nwhole game is getting to the right test on the first move. Fix the\nvignette to one quadrant of a two-by-two, anatomy against mechanism,\nand the test selection falls out of the sort rather than being\nmemorized. This episode builds that grid, then stress-tests it against\nthe alarm-feature framework and the cases that break a careless read.\n \nThe case. A 55-year-old woman has twelve months of progressive dysphagia to\nsolids and liquids, regurgitation of undigested food, nocturnal cough,\nand weight loss. EGD shows a dilated body with residue and a junction\nthat passes with gentle pressure, no mass, biopsies unremarkable. The\nstory is classic achalasia. Do you proceed to myotomy?\n \nTopics covered\n\nTwo axes: oropharyngeal versus esophageal, mechanical narrowing versus motility\nLocalization: throat plus airway symptoms versus substernal sticking after the swallow\nOropharyngeal causes are neuromuscular: stroke, Parkinson, ALS, myasthenia, radiation\nModified barium swallow with a speech pathologist reads the swallow itself; EGD cannot\nSolids-only progressive: ring, web, peptic stricture, EoE, malignancy\nSolids-and-liquids from the start: achalasia, spasm, jackhammer, scleroderma\nEGD with two-level biopsies even on normal-looking mucosa, because EoE is histologic\nBarium esophagram and high-resolution manometry as the second-line motility tests\nAlarm features raise malignancy pretest probability; they do not decide whether to scope\nZenker diverticulum: barium first so the scope does not perforate the pouch\n\n \nKey decisions\n\nNew dysphagia is itself an alarm symptom: a 35-year-old with solid-food dysphagia still gets EGD; the over-50 cutoff is a dyspepsia rule, not a dysphagia rule\nThroat plus cough, nasal regurgitation, or drooling routes to modified barium swallow, not EGD; EGD sees mucosa, not the swallowing maneuver\nSolids-only that progresses over months with weight loss in an older patient is...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}