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MBChB Surgery > Corrosive disease injuries of the esophagus > Flashcards

Corrosive disease injuries of the esophagus Flashcards

1
Q

Define corrosive injuries of the oesophagus

A 
Tissue injury due to chemical reaction on the oesophageal wall 
AKA
- caustic injury
- caustic burns
- caustic ingestion
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2
Q

What is the epidemiology of corrosive oesophageal injuries?

A

Female
1-5yo
>21yo

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3
Q

Name examples of corrosive substances

A 
Car battery acid
Pool acid
Bleach
Detergents
Pool cleaners
Drain cleaners
Potassium permanganate crystals
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4
Q

What is the immediate threat with corrosive oesophageal injury?

A

Airway obstruction

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5
Q

What are the 3 areas of oesphageal narrowing?

A

Cervical (crocoid cartilage)
Thoracic (aortic arch)
Abdominal (oesophageal hiatus)

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6
Q

Name factors that affect the severity of corrosive oesophageal injury

A 
Physical form of substance 
Type of agent
Amount consumed
Concentration
Duration of contact
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7
Q

What critical pH is required for corrosive oesophageal injuries?

A

pH<2

pH>12

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8
Q

What is the general term for alkali in cleaning products?

A

Lye

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9
Q

What is clinically significant about solid lye?

A

Stick to mucosa and cause deep burns

Rarely injure beyond oropharynx and proximal oesophagus

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10
Q

What is clinically significant about liquid lye?

A

Easily swallowed

Quickly cover entire oesophagus

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11
Q

Name the 3 phases of alkaline corrosive injury

A
  1. Liquefactive necrosis
    - 1 to 5 days
    - saponification of fats
    - bacterial and PML invasion
    - protein denaturation
    - blood vessel thrombosis
  2. Reparative phase
    - from 5th day
    - development of granulation tissue
    - collagen deposition
    - mucosal re-epithelialisation
  3. Scar retraction
    - both directions
    - oesophageal shortening
    - strictures
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12
Q

What kind of necrosis do alkalis cause?

A

Liquefactive

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13
Q

What kind of necrosis do acids cause?

A

Coagulative necrosis

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14
Q

What is clinically significant about acid corrosive injuries?

A

Oesophagus often spared

Stomach commonly involved

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15
Q

Name the classification of corrosive injuries

A

Zargar classification

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16
Q

Give the Zargar classification of corrosive injuries

A

Grade 0 - normal mucosa
Grade 1 - edema and erythema of mucosa
Grade 2a - hemorrhage, erosions, blisters, superficial ulcers
Grade 2b - circumferential lesions
Grade 3a - focal deep gray/black-brownish ulcers
Grade 3b - extensive deep gray/black-brownish ulcers
Grade 4 - perforation

16
Q

Give the Zargar classification of corrosive injuries

A

Grade 0 - normal mucosa
Grade 1 - edema and erythema of mucosa
Grade 2a - hemorrhage, erosions, blisters, superficial ulcers
Grade 2b - circumferential lesions
Grade 3a - focal deep gray/black-brownish ulcers
Grade 3b - extensive deep gray/black-brownish ulcers
Grade 4 - perforation

17
Q

Name complications of corrosive injuries

A 
Airway obstruction
Bleeding
Perforation
Strictures
Oesophageal carcinoma
Prepyloric fibrosis
18
Q

Name symptoms of corrosive injury

A 
Oropharyngal pain
Odynophagia
Dysphagia
Drooling
Breathing difficulty
Restrosternal/epigastric pain
19
Q

Name clinical signs on investigation of corrosive injury

A 
Stridor
Bronchospasm
Shock
Abdominal tenderness
Peritonitis
20
Q

Name investigations in corrosive injury

A 
ABG (metabolic acidosis)
U+E
FBC
CXR
Endoscopic U/S 
CT
21
Q

When is endoscopy done in corrosive oesophageal injury?

A

Within 24-48h

Careful, flexible oesophago-gastroscopy

22
Q

When is endoscopy in corrosive injury contraindicated?

A

Suspected perforation

Between day 5-15 post ingestion

23
Q

What is the management of corrosive injuries?

A 
ABCs 
IV line
Fluids
Analgesia
NPO
Manage complications
24
Q

What should you avoid in the management of corrosive injuries?

A

Emesis
Acid neutralisation
Nasogastric tubes

25
Q

How do you identify a battery button on CXR?

A

Halo sign on AP

Typical step on lateral

MBChB Surgery (38 decks)

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