Subject(s)
Education, Medical/trends , Ultrasonography , Curriculum/trends , Europe , Forecasting , Humans , United StatesABSTRACT
Achalasia is a primary esophageal motility disorder characterized by dysphagia, chest pain, and drug-resistant reflux symptoms. A detailed anamnesis and esophageal manometry are essential tools for a correct diagnosis. We present a case of a 31 years old woman with typical achalasia symptoms misdiagnosed for many years due to a complex background picture. Despite the evolution in medical sciences, this clinical case underlines the cornerstones of medical profession: patient-physician relation and bedside clinical approach. At the same time, it confirms the increasing role of ultrasonography as a simple but essential tool for a complete general-internal medicine evaluation.
Subject(s)
Deglutition Disorders/diagnostic imaging , Esophageal Achalasia/diagnostic imaging , Adult , Deglutition Disorders/psychology , Diagnostic Errors , Disease Progression , Esophageal Achalasia/congenital , Esophageal Achalasia/psychology , Female , Humans , Manometry , Physician-Patient Relations , UltrasonographyABSTRACT
Jaundice corresponds to elevated bilirubin- levels, whereat one has to distinguish between direct and indirect serum-bilirubin. In the present Mini Review causes and differential diagnosis of jaundice are outlined. Ultrasound-diagnostic plays a major role in identifying intrahepatic or extrahepatic jaundice. Attention is given to the differential diagnosis of elevated liver enzymes in presence of jaundice, pointing out the distinction between hepatocellular and cholestatic parameters as well as the differentiation in acute or chronic increase. Moreover, the consequences of liver enzyme elevations including further diagnostic procedures, are highlighted. Finally, possibilities and limitations of modern diagnostic tests for liver fibrosis are briefly overviewed.
Jaunisse signifie la présence d'un taux élevé de bilirubine. On distingue entre une hyperbilirubinémie directe et indirecte. Dans la présente compilation sont mentionnées les causes et le diagnostic différentiel de l'ictère. En ce qui concerne la caractérisation de la jaunisse intrahépatique et extrahépatique, l'échographie diagnostique joue un rôle majeur. Le diagnostic différentiel des taux d'enzymes hépatiques élevés en présence d'un ictère est adressé, en soulignant la distinction entre jaunisse hépatocellulaire et cholestatique, ainsi qu'une augmentation aiguë ou chronique. Ensuite, les conséquences de l'élévation des enzymes hépatiques, y compris d'autres procédures de diagnostic sont mises en évidence. Enfin, une attention est dirigée vers les possibilités et les limites des tests de diagnostic modernes pour la fibrose du foie.
