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{{Xyz}}


{{CMG}}; {{AE}}Madhu Sigdel
{{CMG}}; {{AE}} {{MSI}}


== Historical Perspective ==
{{familytree/start |summary=Sample 1}}
{{familytree | | | | | | | | A01 |A01=Check pH on ABG}}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | |B02| | |B01=pH<7.35=Acidosis|B02=pH>7.45=Alkalosis}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01=Check PaCO2}}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | D01 | | D02 | | | | | | D03 |D01=PaCO2 > 45mm Hg = Respiratory acidosis Primary cause: hypoventilation|D02= PaCO2 Normal or > 35mm Hg = Metabolic acidosis|D03=Check PaCO2}}
{{familytree | | | | | | | | | | | |,|-|^|.| }}
{{familytree | | | | | | | | | | |E02| | E03 | |E02=PaCO2 > 45mm Hg = Metabolic alkalosis|E03=PaCO2<35mm Hg = Respiratory alkalosis Primary cause: hyperventilation}}
{{familytree | | | | | | | | | | |!| | | | |!| }}
{{familytree | | | | | | | | | | F01 | | | F02 |F01=HCO3- > 29 eg. vomiting|F02=Check HCO3-}}
{{Familytree | | | | | | | | | | | | |,|-|-|^|-|-|.| | }}
{{Familytree | | | | | | | | | | | |C01 | | | | C02 |C01= Normal or slight decrease = Acute respiratory alkalosis eg. fever, panic attack| C02= Decreased < 24 = Chronic respiratory alkalosis eg. Anemia, CNS causes}}
{{familytree/end}}


=== Discovery ===
==Overview==
* DES was first described by Osgood, in 1889 in 6 patients who presented with chest pain and dysphagia.
The majority of patients with [disease name] are asymptomatic.


* Creamer (1954) made the first manometric descriptions of DES.
OR


== Classification of DES ==
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
* There is no established system for the classification of DES although it is categorized as one of the major disorders of peristalsis according to The Chicago Classification v.3.0.


== Risk Factors ==
==History and Symptoms==
* Common risk factors in the development of Diffuse Esophageal Spasm include Age (60-80 years), presence of GERD, Hypertension, anxiety or depression, and drinks (eg. red wine, very hot or cold liquid or fluid).
*The majority of patients with [disease name] are asymptomatic.
OR
*The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
*Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].  
===History===
Patients with [disease name]] may have a positive history of:
*[History finding 1]
*[History finding 2]
*[History finding 3]
===Common Symptoms===
Common symptoms of [disease] include:
*[Symptom 1]
*[Symptom 2]
*[Symptom 3]


== Pathophysiology ==
===Less Common Symptoms===
Less common symptoms of [disease name] include
*[Symptom 1]
*[Symptom 2]
*[Symptom 3]


=== Pathogenesis ===
==References==
* The exact pathogenesis of DES is not fully understood. However, current high-resolution manometric studies suggest impairment of inhibitory myenteric plexus neuron. These neurons use nitric oxide (NO) as neurotransmitter. Hence, these patients may also have dysregulation of endogenous NO synthesis or/and degradation<ref name="pmid4196712">{{cite journal| author=Orlando RC, Bozymski EM| title=Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm. | journal=N Engl J Med | year= 1973 | volume= 289 | issue= 1 | pages= 23-5 | pmid=4196712 | doi=10.1056/NEJM197307052890106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4196712  }}</ref>. The final result is premature and rapidly propagated or simultaneous contraction of smooth muscles of distal esophagus.
{{Reflist|2}}
References<references />


== Natural History, Complications, and Prognosis ==
{{WH}}
 
{{WS}}
=== Natural History ===
[[Category: (name of the system)]]
* The symptoms of DES usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
* The symptoms of (disease name) typically develop ___ years after exposure to ___.
* If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
 
=== Complications ===
* Common complications of [disease name] include:
** [Complication 1]
** [Complication 2]
** [Complication 3]
 
=== Prognosis ===
* Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
* Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
* The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
* [Subtype of disease/malignancy] is associated with the most favorable prognosis.
* The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.
 
== References ==
 
== Diagnostic Criteria ==
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
** [Criterion 1]
** [Criterion 2]
** [Criterion 3]
** [Criterion 4]
* The diagnosis of DES is based on The Chicago Classification criteria using high resolution esophageal manometry
** [Criterion 1]
** [Criterion 2]
** [
 
== References ==

Latest revision as of 17:55, 26 February 2018

Xyz Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]

 
 
 
 
 
 
 
Check pH on ABG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
pH<7.35=Acidosis
 
 
 
 
 
 
 
pH>7.45=Alkalosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check PaCO2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PaCO2 > 45mm Hg = Respiratory acidosis Primary cause: hypoventilation
 
PaCO2 Normal or > 35mm Hg = Metabolic acidosis
 
 
 
 
 
Check PaCO2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PaCO2 > 45mm Hg = Metabolic alkalosis
 
PaCO2<35mm Hg = Respiratory alkalosis Primary cause: hyperventilation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
HCO3- > 29 eg. vomiting
 
 
Check HCO3-
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal or slight decrease = Acute respiratory alkalosis eg. fever, panic attack
 
 
 
Decreased < 24 = Chronic respiratory alkalosis eg. Anemia, CNS causes

Overview

The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

History and Symptoms

  • The majority of patients with [disease name] are asymptomatic.

OR

  • The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
  • Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

History

Patients with [disease name]] may have a positive history of:

  • [History finding 1]
  • [History finding 2]
  • [History finding 3]

Common Symptoms

Common symptoms of [disease] include:

  • [Symptom 1]
  • [Symptom 2]
  • [Symptom 3]

Less Common Symptoms

Less common symptoms of [disease name] include

  • [Symptom 1]
  • [Symptom 2]
  • [Symptom 3]

References

Template:WH Template:WS

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