00:01
We move away from rings
and we go into webs.
00:05
Now, in terms
of the presentation here
rings and webs,
are oftentimes
interchange by clinicians,
you cannot afford to do that
as a medical student or a resident.
00:17
So ring would be
down in as we showed,
with the lower esophagus
and 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.
00:36
And obviously emphasizing
the location of the web
versus location of a ring.
00:41
The web almost always will
be in the upper and mid
as far as you're concerned,
Very rarely
would it be in the lower
Ultimately, though,
you're causing what?
Compromise of the lumen.
00:53
A fixed obstruction.
00:55
So therefore,
the patient has dysphasia
to both solids and liquids.
00:59
Now, the web's
because of the invagination
of squamous cells
do not worry so much about
the upper and the lower aspect
because all of it will be
squamous
webs.
01:10
Last time we've heard of this is,
what if I told you?
Well, the patient comes in.
01:15
Patient says, "Hey, Doc,
I'm having a hard time eating."
"Tell me about your eating pattern.
01:21
Are you having a hard time
eating your dinner? Solid foods?"
"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."
"Okay."
Next, you take a look at the nails
and it looks like they're depressed.
01:46
Spooning of the nails.
01:48
And upon physical examination,
you check out the tongue
and the tongue looks
beefy, beefy red.
01:56
Go on to find out that
there's an iron deficiency.
02:00
Obviously, here we're dealing with
Plummer-Vinson syndrome.
02:02
Plummer-Vinson syndrome
is a condition with
iron deficiency anemia
associated with dysphasia
due to the presence
of esophageal webs.
02:11
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.
02:25
Worst case scenario.
Do not forget.
02:30
Here with the web,
once again, a little bit different,
not in terms of the dilation.
02:36
The dilatation is going to
be part of the management.
02:39
But with Plummer-Vinson syndrome,
which should be highly differential
with the web,
Iron, patients iron deficient.
Iron therapy.