Oesophagus

Question 1

Clinical findings in Boerhaave’s:

Answer 1

Classic triad:
- Vomiting
- Chest pain
- Subcut emphysema
–>Only in 20%

+
SIRS
Hamman’s crunch

Always consider if chest pain PLUS vomiting or childbirth/ exertional

Question 2

3 diagnostic methods (+findings) in Boerhaaves:

Answer 2

CXR:
Pleural effusion
Widened mediastinum
Air under diaphragm

CT:
Gas and fluid in mediastinum
Per (usually distal 3rd)

Oesophagram:
Gastrograffin
NOT barium- tissue damage.

Question 3

Which antibiotic for Boerhaaves?

Answer 3

IV Augmentin 1.2g 8 hourly

Question 4

Common locations for food bolus to get stuck:

Answer 4

Cricopharyngeus muscle (75%)
Where aorta crosses
Lower sphincter

Question 5

What medications can be used for food bolus obstruction?

Answer 5

• 24 hour conservative trial of passage
• Glucagon 1-2mg IV (risk of vomit, give antiemetic first)

GTN no longer recommended (hypoTN)
Carbonated no longer recommended (aspiration, perf)

Question 6

How long can an oesophageal foreign body be left in situ?

Answer 6

Needs resolution within 24 hours or risk of perforation

Question 7

Indications for urgent endoscopy in oesophageal foreign body:

Answer 7

OBJECT
- Sharp
- Button battery
- Multiple magnets
- Coin at cricopharyngeus
- Unlikely to pass pylorus: >2cm, >6cm
- Toxic (eg. Lead)

CLINICAL
- Complete obstruction (X secretions)
- Perforation

Question 8

Mallory-Weiss:

Answer 8

Superficial mucosal laceration near gastro-oesoph junction

Repeated vomiting:
- ETOH
- Hyperemesis
- Bulimia
Or repeated valsalva:
- Coughing
- CPR
- Straining

CAN cause big bleed, but not common. If lots, think alternative like varices, Booerhaaves, fistula etc.