U Assessment

HISTORY. Obtain an accurate history of risk factors, including race, cultural background, use of cigarettes and alcohol, or any esophageal problems. Dysphagia, which is often the most common symptom, is usually experienced when at least 60% of the esophagus is occluded. Initially, it is mild and intermittent, and it occurs only with solid foods. Patients may report a sensation that "food is sticking in their throat." Symptoms of the disease soon progress to the inability to swallow semisoft or liquid food, and the patient experiences a severe weight loss, as much as 40 to 50 pounds over 2 to 3 months. Eventually, the patient is unable to swallow her or his own saliva. Also inquire about regurgitation, vomiting, chronic hiccups, odynophagia (painful swallowing), and dietary patterns. Patients may report pain radiating to the neck, jaw, ears, and shoulders.

PHYSICAL EXAMINATION. Observe the patient's ability to swallow food. Note any chronic coughing and increased oral secretions. Listen to the patient's voice: Tumors in the upper esophagus can involve the larynx and cause hoarseness. Place the patient in the recumbent position; pain, hoarseness, coughing, and potential aspiration often occur in this position. Weigh the patient, and determine the patient's strength and motion of the extremities. Severe weight loss and weakness are common symptoms.

PSYCHOSOCIAL. The patient needs to make a psychological adjustment to the diagnosis of a chronic illness that is usually terminal. Evaluate the patient for evidence of altered mood (such as depression or anxiety), and assess the coping mechanisms and support systems.

Diagnostic Highlights

Test Normal Result

Abnormality with Condition

Explanation

Barium swallow Normal esophagus

Irregular areas in or

Locates and describes

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