Caustic Ingestion

Question 1

Indication for urgent ogdscopy (12-24hrs) after caustic ingestion?

Answer 1

Symptomatic ingestion (drooling, vomiting, dysphagia, odynophagia, chest pain) requires urgent assessment with upper GI endoscopy to assess the degree of ulceration (Zargar classification). Extensive injury on endoscopy should prompt consideration of urgent surgical exploration

Question 2

When can you discharge a Caustic ingestion patient on the same day.

Answer 2

Asymptomatic ingestion can usually be discharged after a trial of oral fluid and a period of observation.

Question 3

Why should we avoid endoscopy between days 5 and 15 post ingestion of caustic?

Answer 3

most guidelines advocate avoiding endoscopy between days 5 and 15 post ingestion when oesophageal strength is at its lowest (based on experimental data from animal models).

Question 4

Indications for Urgent upper GI surgical referral after caustic ingestion

Answer 4

Signs of perforation present (surgical emphysema, mediastinal widening on chest x-ray)

Question 5

Acute management of caustic ingestion

Answer 5

ABCDE
High dose IV PPI
Ogd or trial of oral fluids