We move away from rings
and we go on to webs.
Now, in terms of the presentation here, rings and webs,
rings and webs are often times interchanged by clinicians.
You cannot afford to do that.
As a medical student or a resident.
So ring would be down in, as we
showed, with the lower esophagus.
An esophageal web will be
more so in the upper portion.
Congenital anomalies characterized
by one or more thin, thin
horizontal membrane of squamous epithelium
in the upper and mid-esophagus.
I’m obviously emphasizing the location
of the web versus the location of a ring.
The web almost always will be in the upper
and mid, as far as you’re concerned.
you’re causing what?
Very rarely would it be in the lower.
Compromise of the lumen.
A fixed obstruction.
So therefore the patient has dysphagia
to both, both solids and liquids.
Now the webs, because of the invagination of
the squamous cells, do not worry so much about the upper
and the lower aspect because all
of it will be squamous, squamous, squamous.
Last time we've heard of this is, what if
I told you, well the patient comes in.
The patient says, “Hey Doc,
I’m having a hard time eating."
“Tell me about your eating pattern.
Are you having a hard
time eating your dinner?
“ I am."
“And what about your fluids?"
“Yeah, I’m having a hard
time drinking my shake."
“Okay, do you find that there was a
progression in terms of difficulty?"
“No, it was at the same time."
Next you take a look at the nails and it looks
like they’re depressed, spooning of the nails.
And upon physical examination you check out the
tongue and the tongue looks beefy, beefy red.
Go on to find out that
there’s iron deficiency.
Obviously here we’re dealing
with Plummer-Vinson syndrome.
Plummer-Vinson Syndrome is your koilonychia - spooning of the
fingernails, spooning, there’s esophageal
webs, iron deficiency anemia.
And because the web is made up of
squamous cell, with persistent irritation
may go on to develop dysplasia and
squamous cell cancer of the esophagus.
Worst case scenario.
Do not forget it.
Here with the web, once again, a little bit
different, not in terms of the dilation.
So the dilatation is going to be part of the
management, but with Plummer-Vinson Syndrome
which should be high on your differential
with the web; Iron, patient’s iron deficient.