Internal Medicine

P1: RLJ/OZN P2: PSB

0521779407-D-02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:9

514 Dysphagia Dyspnea

Stricture

■benign: endoscopic dilation, proton pump inhibitor for peptic stric-

ture

■malignant: surgery for early staging, endoscopic stent placement,

laser

Spasm

■nitrates, calcium-channel blocker

Achalasia

■pneumatic dilation, botulinum toxin injections (short acting),

myotomy surgery

follow-up

■Periodic visits for symptom survey to determine effectiveness of ther-

apy and need for additional treatment strategies

complications and prognosis

Prognosis

■good if diagnosis confirmed and therapy effective

Complications

■aspiration pneumonia

■weight loss

Dyspnea...........................................

THOMAS J. NUCKTON, MD

history & physical

■Dyspnea: subjective difficulty or distress in breathing

■Orthopnea: dyspnea when supine; characteristic of CHF; may occur

with asthma, other obstructive lung diseases, diaphragmatic paral-

ysis

■Trepopnea: dyspnea only in the lateral decubitus position; seen with

heart disease, unilateral pulmonary or pleural disease, unilateral

pleural effusion

■Platypnea: dyspnea only when upright; seen in pulmonary disease

that affects lung bases, also congenital heart disease with right-to-

left shunting on standing

■Paroxysmal nocturnal dyspnea: attacks of dyspnea at night; “cardiac

asthma” with CHF and valvular heart disease; patients with pul-

monary disease may also experience sudden onset dyspnea at night