|VIEW THE MOBILE VERSION of www.homemedicine.ca|| Informational|
Medical ArticlesAuricular Fibrillation Diagnosis
If the pulse is intermittent and there is apparently a heart ...
Eyes Failing Sight
This often comes as the result simply of an over-wearied body ...
Pulmonary Insufficiency Pulmonary Regurgitation
If this rare condition occurs, it is probably congenital. A ...
Hurry, Worry, And Irritability
PROBABLY most people have had the experience of hurry...
Myocarditis Fibrous Management
The advice he should receive is well understood: to avoid phy...
To Prevent Colds
Keep the _arms_, _hands_ and _chest_ well clothed and warm. ...
Bruises Case Xix
Robert Hill, aged 16, received a blow yesterday from a bone w...
Methods Of Treatment
Irritating applications probably provoke recurrences, becaus...
By this term we mean not only the sensible perspiration which ...
Treatment Of Broken Compensation
The consideration of this subject will include the following ...
Burns Case Xxxiii
A little girl, aged 10, scalded her breast a week ago and has...
Ulcers Case Xxi
Mrs. Butcher, aged 52, has two ulcers a little above the oute...
ALTHOUGH so much time and care are given to the vario...
Elsie was twenty. She came to see me because I had helped Els...
Suck the wound, and apply a drop or two of strong ammonia to t...
The Surgical Dissection Of The Superficial Structures Of The Male Perinaeum
The median line of the body is marked as the situation where ...
Breath And Blood
Often difficulty of breathing, especially in close air, mistak...
Why Does Mrs Smith Get On My Nerves?
IF you want to know the true answer to this question ...
On The Adherent Eschar
It appears scarcely necessary to describe the immediate and w...
A sensation sometimes very much annoys patients, which they de...
Differential Diagnosis Of Ulcer Of The Esophagus
Category: DISEASES OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Simple ulcer requires the exclusion of lues, tuberculosis,
epithelioma, endothelioma, sarcoma, and actinomycosis. Simple ulcer of
the esophagus is usually associated with stenosis, spastic or organic.
Luetic ulcers commonly show a surrounding inflammatory areola, and
they usually have thickened elevated edges, generally free from
granulation tissue, with a pasty center not bleeding readily when
sponged. The Wassermann reaction may contribute to the diagnosis; but
if negative, a thorough and prolonged test with mercury is imperative.
It must be remembered that a person with lues may have a simple,
mixed, or malignant ulceration of the esophagus, or the three lesions
may even be combined. It may be in some cases possible to demonstrate
the treponema pallidum in scrapings taken from the ulcer.
The single tuberculous ulcer is usually pale, superficial, and
granular in base. If it is a continuation from more extensive
extra-esophageal tuberculous ulceration, pale cauliflower granulations
may be present. Slight cicatrices may be seen. Tuberculosis in other
organs can almost always be demonstrated by roentgenographic,
physical, or laboratory studies. Tuberculin tests and animal injection
with an emulsion of a specimen of tissue may be required. The specimen
must be taken very superficially to avoid risk of perforation.
Sarcomatous ulcers do not differ materially in appearance from those
of carcinoma, but they are much more rare.
Carcinomatous ulcer is usually characterized by the very vascular
bright red zone, raised edges, fungations, granulation tissue that
bleeds freely on the lightest touch, and above all, it is almost
invariably situated on an infiltrated base which communicates a
feeling of hardness to the pressure of sponges or the esophagoscope
itself. A scar may be from the healing of an ulcer from stasis, or one
of specific or precancerous character. It may be a cancerous process
developing on the site of a scar, so that the presence of scar tissue
does not absolutely negative malignancy. As a rule, however, scars are
absent in cancer of the esophagus. The firm and sometimes prominent
ridge of the crossing of the left bronchus must not be mistaken for
infiltration, and the esophagoscopist must be familiar with the normal
rigidity of the cricopharyngeus.
 Mixed infection gives to all esophageal ulceration a certain
uniformity of appearance, so that laboratory studies of smears or
histologic and bacteriologic study of tissue specimens taken from
fungations or thickened edges are often required to confirm the
endoscopic diagnosis. If the edges are thin and flat, the taking of a
specimen involves some risk; fungations can be removed without risk;
so can nodules, but care must be taken that projecting folds are not
mistaken for nodules. It is always wise to push the therapeutic test
with potassium iodid and especially mercury in any case of esophageal
ulceration unassociated with stasis.
Next: Treatment Of Acute And Subacute Inflammation And Ulceration Of The Esophagus
Previous: Ulceration Of The Esophagus