Dysphagia

1. Dysphagia Stephen Antonik, MD Jasmohan Bajaj, MD 6/11/07

2. HPI 60 year old woman status post kidney-pancreas transplant 1989 on immunosupression.� 10/06 history of esophageal stricture as an inpatient, s/p dilation of a tight stricture at 30 cm, biopsies negative for infection or cancer Dilation resulted in bleeding, esophagram after dilation showed no leak Patient was lost to f/u until 4/07 at which time she had difficulty swallowing pills and therefore was at risk of rejection She had wt loss, no abd pain, no fevers 4/07 clinic visit, the following was ordered: manometry, EGD

3. type 1 diabetes, currently on no insulin due to the kidney-pancreas transplant 1989 squamous cell carcinoma of the scalp osteoporosis history of UTIs history of TIAs iron-deficiency anemia left knee replacement bilateral cataract surgery hysterectomy PMH/PSH

4. Prednisone 5 mg daily CellCept 500 mg bid Septra 3 times per week Cyclosporin A 125 mg bid Protonix 40 mg bid Iron Tylenol PRN Medications

5. Physical Exam Wt 118 Ht 5�3� CONSTITUTIONAL: no acute distress, comfortable SKIN: no jaundice, no rashes LYMPH: no lymphadenopathy NECK: FROM, no masses, no thyroid nodules or masses MOUTH: MMM, uvula midline, no masses CV: regular rate and rhythm, normal S1 and S2, no edema RESP: clear to auscultation GI: soft, nontender, nondistended, normal active bowel sounds, no guarding, no rebound, no masses, no hepatosplenomegaly

6. Labs Hemoglobin 11, MCV 99 Albumin 3.1, Creat 1.0

7. EGDs