Corrosive disease injuries of the esophagus Flashcards
Define corrosive injuries of the oesophagus
Tissue injury due to chemical reaction on the oesophageal wall AKA - caustic injury - caustic burns - caustic ingestion
What is the epidemiology of corrosive oesophageal injuries?
Female
1-5yo
>21yo
Name examples of corrosive substances
Car battery acid Pool acid Bleach Detergents Pool cleaners Drain cleaners Potassium permanganate crystals
What is the immediate threat with corrosive oesophageal injury?
Airway obstruction
What are the 3 areas of oesphageal narrowing?
Cervical (crocoid cartilage)
Thoracic (aortic arch)
Abdominal (oesophageal hiatus)
Name factors that affect the severity of corrosive oesophageal injury
Physical form of substance Type of agent Amount consumed Concentration Duration of contact
What critical pH is required for corrosive oesophageal injuries?
pH<2
pH>12
What is the general term for alkali in cleaning products?
Lye
What is clinically significant about solid lye?
Stick to mucosa and cause deep burns
Rarely injure beyond oropharynx and proximal oesophagus
What is clinically significant about liquid lye?
Easily swallowed
Quickly cover entire oesophagus
Name the 3 phases of alkaline corrosive injury
- Liquefactive necrosis
- 1 to 5 days
- saponification of fats
- bacterial and PML invasion
- protein denaturation
- blood vessel thrombosis - Reparative phase
- from 5th day
- development of granulation tissue
- collagen deposition
- mucosal re-epithelialisation - Scar retraction
- both directions
- oesophageal shortening
- strictures
What kind of necrosis do alkalis cause?
Liquefactive
What kind of necrosis do acids cause?
Coagulative necrosis
What is clinically significant about acid corrosive injuries?
Oesophagus often spared
Stomach commonly involved
Name the classification of corrosive injuries
Zargar classification
Give the Zargar classification of corrosive injuries
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
Give the Zargar classification of corrosive injuries
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
Name complications of corrosive injuries
Airway obstruction Bleeding Perforation Strictures Oesophageal carcinoma Prepyloric fibrosis
Name symptoms of corrosive injury
Oropharyngal pain Odynophagia Dysphagia Drooling Breathing difficulty Restrosternal/epigastric pain
Name clinical signs on investigation of corrosive injury
Stridor Bronchospasm Shock Abdominal tenderness Peritonitis
Name investigations in corrosive injury
ABG (metabolic acidosis) U+E FBC CXR Endoscopic U/S CT
When is endoscopy done in corrosive oesophageal injury?
Within 24-48h
Careful, flexible oesophago-gastroscopy
When is endoscopy in corrosive injury contraindicated?
Suspected perforation
Between day 5-15 post ingestion
What is the management of corrosive injuries?
ABCs IV line Fluids Analgesia NPO Manage complications
What should you avoid in the management of corrosive injuries?
Emesis
Acid neutralisation
Nasogastric tubes
How do you identify a battery button on CXR?
Halo sign on AP
Typical step on lateral
