Chapter 77: Esophageal Emergencies Flashcards
Normal length of oesophagus?
20-25cm
The upper sphincter is composed primarily of the cricopharyngeus muscle, with a resting pressure of around ____
The upper sphincter is composed primarily of the cricopharyngeus muscle, with a resting pressure of around 100 mm Hg
Three anatomic constrictions affect the adult esophagus
- At the cricopharyngeus muscle (C6)
- At the level of the aortic arch (T4)
- At the gastroesophageal junction (T10 to T11)
Five anatomic constrictions affect the pediatric esophagus
- At the cricopharyngeus muscle (C6)
- At the thoracic inlet (T1)
- At the level of the aortic arch (T4)
- At the tracheal bifurcation (T6)
- At the gastroesophageal junction (T10 to T11)
This can lead to massive upper GI bleeding
Variceal dilatation of the submucosal system
Type of esophageal dysphagia that first with difficulty swallowing solids, then liquid
Mechanical or obstructive disease
Is throat and chest pain with swallowing and usually signifies esophageal inflammation, infection, or erosion
Odynophagia
What are the common cause of odynophagia
- Candida
- Herpesvirus
- Cytomegalovirus
Primary cause of reflux?
Transient relaxation of the lower esophageal sphincter complex
Type of esophageal dysphagia that has difficulty swallowing solids and liquid
Motility disorder
Classic symptom of gastroesophageal reflux disease (GERD)
Heartburn
A reasonable approach is to start treatment of GERD
Histamine-2 receptor antagonists, and if there is no improvement in 2 weeks, stop the current treatment and start a proton pump inhibitor
Time needs not to lie down after eating so GERD will not develop
3 hours
Risk factors for pill-induced esophageal injury include
Risk factors for pill-induced esophageal injury include swallowing position, fluid intake, capsule size, and patient age
A chronic allergic- inflammatory condition in which eosinophils and other immune system cells infiltrate the esophagus and induce an inflammatory response, in response to foods, allergens, or acid reflux
Eosinophilic esophagitis
Treatment for eosinophilic esophagitis
- Avoidance of allergens
- Oral liquid corticosteroids or inhaled corticosteroids
Most common pathogen of infectious esophagitis
Candida
Treatment for infectious esophagitis
Fluconazole 400mg/day for 2 weeks
The most frequent cause of esophageal perforation
Iatrogenic perforation
Is full-thickness perforation of the esophagus after a sudden rise in intraesophageal pressure
Boerhaave’s syndrome
Most common site of perforation in boerhaave’s syndrome
Distal esophagus on the left posterolateral wall
Caused by air in the mediastinum that is being moved by the beating heart, can sometimes be auscultated
Hammans’ crunch
If CT is negative for esophageal rupture but clinical suspicion is still high, what is the next step?
If CT is negative for esophageal rupture but clinical suspicion is still high, flexible video esophagoscopy or esophagography, or both
Age group most common seen swallowed foreign body
Children 18 to 48 months of age
True or False
In children the impaction happen at distal while in adult is proximal
False
In children the impaction happen at proximal while in adult is distal
Size usually dislodge at distal to the pylorus
> 2.5cm wide and >6cm long
True or False
Coins in the esophagus generally present their circular face on anteroposterior films (coronal alignment), as opposed to coins in the trachea, which show that face on lateral films
True
Coins in the esophagus generally present their circular face on anteroposterior films (coronal alignment), as opposed to coins in the trachea, which show that face on lateral films
Very high-yield test for esophageal foreign body
CT scan
For distal esophageal objects, it is given and has been reported to relax the lower sphincter and allow passage of the object
Glucagon 1 to 2 mg/IV
The food most commonly identified in food impaction
Meat
In patient with food impaction, you can use proteolytic enzymes?
No. because it can cause mucosal injury
True or False
Button batteries that have passed the esophagus can be managed expectantly, as long as follow-up in 24 hours can be ensured. Repeat films should be obtained at 48 hours to ensure that the cell has passed through the pylorus
True
Button batteries that have passed the esophagus can be managed expectantly, as long as follow-up in 24 hours can be ensured. Repeat films should be obtained at 48 hours to ensure that the cell has passed through the pylorus
Most batteries pass completely through the body within?
48 - 72 hours
American Society for Gastrointestinal Endoscopy guidelines recommend removal of sharp objects by endoscopy while they are in the ____
American Society for Gastrointestinal Endoscopy guidelines recommend removal of sharp objects by endoscopy while they are in the stomach or duodenum
IF with sharp foreign body and intestinal perforation occurs, it is usually at the?
Ileocecal valve
A favored packet is the ____, which may hold up to ____ of narcotic
A favored packet is the condom, which may hold up to 5 grams of narcotic
