allergies: patient recorded as having no known allergies to drugs attending: chief complaint: chief complaint: chicken bone in throat, esophageal foreign body icu admission reason: gi scope major surgical or invasive procedure: gd history of present illness: this is a 57 y.o. male without significant pmhx presenting with ? of foreign body in his throat. the patient reported he was eating boneless sweet and sour chicken on the evening pta when he felt like he got something caught in his throat. since that time, he has been unable to swallow liquids or solids and feels as if these things get stuck in one place and comes back up when he attempts to swallow. this is associated with pain in his nec around the sternal notch. he denies vomiting, hematemesis, or problems with secretions. he denies any respiratory symptoms. he presented to the ed for further evaluation of his dysphagia. in ed, vital signs were stable with t 98.2, bp 153/105, hr 92, rr 20,and o2 sat of 100% on room air. his physical exam was unremarkable. exam unremarkable, no mouth drooling, no e/o in oropharynx if obstruction or any stridor, lungs clear to auscultation. administered two doses of glucagon in an attempt to relax muscles of pharynx. gi consulted, plan for egd. transferred to for gi scope; vital signs stable upon transfer. on arrival patient reporting pressure in throat after eats and "gurgling" but denies particular pain. reporting with gagging he is having some discomfort in his back. no vomiting. continues to deny respiratory issues or chest pain. no fevers, chills, night sweats, or wt loss. pt did have some wretching upon transfer to . . review of sytems: negative for systemic symptoms like fevers, chills, night sweats, or weight. past medical history: 1. "lung procedure" in 70s - ?biopsy 2. past ivdu abuse in 90s - poor peripheral veins 3. past tobacco abuse social history: social drinker. no tobacco for 4 mos, prior smoked 1pack per day. past ivdu in 90s, not in over 15 yrs. currently works in retail. family history: notable for diabetes in his father. physical exam: t=98 bp=137/87 hr=87 rr=14 98%ra general: pleasant, well appearing, nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . lungs: ctab, good air movement biaterally, no stridor abdomen: nabs. soft, nt, nd. no hsm extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. normal coordination. gait assessment deferred psych: listens and responds to questions appropriately, pleasant pertinent results: xray neck/soft tissues: no radiographic evidence of extraluminal air or radiopaque foreign body in neck. cxr: no radiographic evidence for foreign body or pneumomediastinum. ct neck w/o contrast: - no esophageal fb identified - no mediastinal air or fluid identified - fluid in mid esophagus - may reflect reflux brief hospital course: 57 y.o. male without significant pmhx presenting with ? of foreign body in his throat, admitted to pending egd. . # dysphagia/foreign body sensation: unclear etiology and differential was broad. presence of actual foreign body vs simply foreign body sensation, which could arise from any inflammatory, irritative process of esophagus including previous trauma or gerd was considered. regurgitation and inability to eat are particularly concerning and would of course be concerned of esophageal ca vs stricture or other consequence of long term minimally symptomatic gerd. zenker's diverticulum would be another possible cause of retention and regurg. gastroenterology performed an egd in icu, identified esophageal webs in superior and inferior aspects of esophagus with minimal dilation of these webs. plan to dilate esophagus at future date, likely by gastroenterology. patient and family were given number to gi to arrange this procedure. patient was discharged to home with omeprazole 20mg . . pt was also advised to establish primary care for routine health maintenance either at to which the number was given or another primary care provider. should follow up on his minimally elevated lfts and likely needs screening for hepatitis and hiv given his h/o ivdu. medications on admission: none discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* discharge disposition: home discharge diagnosis: esophageal webs. esophagitis, gastritis discharge condition: good discharge instructions: you were admitted because you felt like you had some food stuck in your throat. this feeling resolved once you arrived in our icu. while you were here, you also had an upper endoscopy which revealed some webs in your esophagus as well as irritation of your esophagus, stomach and early part of your small intestine. you can resume a diet of clear liquids until 6pm tonight at which time you can eat soft solids. you may resume a normal diet tomorrow morning. chew your food well, and eat small bites. we started you on a proton pump inhibitor called prilosec(or omeprazole) for the irritation of your esophagus. please follow up as below. please call your doctor or return to the ed if you have increase in nausea or vomitting, blood in your stool, black tarry stools, fever, chest pain, the sensation of choking or any other concerning symptoms. followup instructions: call on monday to schedule an egd (upper endoscopy) with dr. this thursday for further dilation of your esophageal webs. you need to establish primary care. if you would like primary care at , you can call at and schedule a new pt appointment. they should follow up your liver enzymes and do hepatitis serologies. you also need to be followed for routine screening and health maintenance. Procedure: Other endoscopy of small intestine Dilation of esophagus Diagnoses: Unspecified gastritis and gastroduodenitis, without mention of hemorrhage Other esophagitis Tracheoesophageal fistula, esophageal atresia and stenosis