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Osler Round 8 - 80/F with difficulty swallowing
Understanding priorities of diagnostic, palliative and curative management of difficulty in swallowing.
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An 80-year-old female presents with a 2-month history of painless, progressive dysphagia (initially to solids, now to liquids). She constantly regurgitates undigested food, accompanied by temporary squeezing epigastric pain and mild hiccups. Over the past 4 days, she developed severe dizziness and constipation. On examination, she is frail but of normal weight, with mild epigastric tenderness. No pallor, jaundice, or lymphadenopathy is noted. An abdominal ultrasound scan reported "cholecystitis and biliary sludge." Caretakers rejected a nasogastric (NG) tube for feeding.
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