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Surgery- UGIT > Corrosive Injury Of The Oesophagus > Flashcards

Corrosive Injury Of The Oesophagus Flashcards

1
Q

What is the definition of corrosive injuries to the oesophagus?

A

Implies there has been tissue damage due to a chemical reaction on the oesophageal wall. Referred to as

  • Caustic injury
  • Caustic Burns
  • Caustic ingestion
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2
Q

What are few examples of these caustic agents

A

These agents are usually acidic or alkaline, available in various forms like crystals and liquids. They include:

  • Car battery acid
  • Pool acid
  • Bleaches
  • Detergents
  • Pool cleaners
  • Drain cleaners
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3
Q

What is the immediate threat of ingesting one of these caustic agents?

A

Involvement of the airway passage

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4
Q

Note that the oesophagus has 3 narrowings which are more prone to caustic injury .
What is the reason for this?

A

This is because there is a relative hold up of the liquid in these areas

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5
Q

Severity of the injury is determined by 4 main determinants. What are they?

A

Amount of agent consumed
Type of agent consumed
Concentration of the agent consumed
Duration of contact

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6
Q

What is the critical PH of an alkaline agent required to cause severe oesophageal injury?

A

PH of 11 and above

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7
Q

What does the term “Lye” refer to?

A

This the general term used for alkaline cleaning products

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8
Q

What are the dangers of ingesting solid lye products (crystals)?

A
  • Tend to adhere to the mucosa
    • Cause deep burns where they adhere
    • Rarely cause injury beyond the oropharynx and proximal oesophagus
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9
Q

What are the dangers of ingesting liquid lye products (crystals)?

A
  • When swallowed, the liquid covers the entirety of the oesophagus.
    • Injury occurs easily within seconds or minutes
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10
Q

What type of necrosis takes place in alkaline corrosive injury?

A

Liquefactive necrosis

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11
Q

What are the 3 phases of alkaline corrosive injury:

A
  1. Liquefactive necrosis
  2. Reparative phase
  3. Scar retraction
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12
Q

Explain phase 1 of an alkaline corrosive injury:

A

Liquefactive necrosis:

  • Happens between 1-5 days
  • Diffuses into deeper lawyers
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13
Q

Explain phase 2 of an alkaline corrosive injury:

A

Reparative phase:
- Begins from 5th day
- Development of granulation tissue
- Collagen deposition (peaks in week 2).
- Mucosal re-epithelialisation
> Fibroblast and collagen matrix results in severe oesophageal dysmotility

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14
Q

Explain phase 3 of an alkaline corrosive injury:

A

Scar retraction

  • Occurs in both longitudinal and circumferential direction
  • Results in both oesophageal shortening and stricture formation.
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15
Q

What type of necrosis takes place in acid injuries?

A

Coagulation necrosis

- The coagulum helps to limit penetration into deeper layers

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16
Q

Why is the oesophagus often mildly damaged or spared in the case of acidic injury?

A

This may be due to the more neutral oesophageal environment leading into the stomach
Stomach is often involved -: Pulling of the acid in the stomach and pyloric spasm

17
Q

Zargar classification and its corresponding endoscopic description:
What does Grade 0 Zargar classification correlate with?

A

Normal mucosa

18
Q

Zargar classification and its corresponding endoscopic description:
What does Grade I Zargar classification correlate with?

A

Edema and erythema of the mucosa

19
Q

Zargar classification and its corresponding endoscopic description:
What does Grade IIa classification correlate with?

A

Hemorrhage
Erosions
Blisters
Superficial blisters

20
Q

Zargar classification and its corresponding endoscopic description:
What does Grade IIb classification correlate with?

A

Circumferential lesions

21
Q

Zargar classification and its corresponding endoscopic description:
What does Grade IIIa classification correlate with?

A

Focal deep gray or brownish-black ulcers

22
Q

Zargar classification and its corresponding endoscopic description:
What does Grade IIIb classification correlate with?

A

Extensive deep gray or brownish-black ulcers

23
Q

Zargar classification and its corresponding endoscopic description:
What does Grade IV classification correlate with?

A

Perforation

24
Q

Name 3 complications are associated with corrosive injuries:

A
  1. Airway obstruction
    • Due to involvement with upper airway
    • Laryngeal oedema
    • Threatening airway obstruction.
  2. Bleeding
    • Rarely a major issue
  3. Perforation
    • Especially with trans mural injuries
    • Leads to mediastinitis
25
Q

What are the symptoms of corrosive injury?

A
  1. Oropharyngeal pain
  2. Odynophagia
  3. Breathing difficulty
  4. Dysphagia
  5. Drooling and saliva
26
Q

During the examination of the patient, signs should you as a physician look out for? (3)

A
  1. Respiratory signs :- Stridor, Bronchospasm
  2. General conditions :- Shock
  3. Abdominal signs :- Tenderness and Peritonitis
27
Q

What investigations should be done when a corrosive injury is suspected?

A
  1. Blood/gas analysis
    • Often deranged in severe cases
  2. Urea and electrolytes/ blood count
  3. Chest x-rays
    • Look for signs of aspiration
    • May show mediastinal air if there is perforation
  4. Endoscopic ultrasound.
    • Shows different levels of the oesophagus
  5. CT scan
    • Can show depth of necrosis and trans-mural damage
    • Non-invasive and valuable I’m some patients
28
Q

Name 3 management steps for corrosive injury:

A
  1. ABC Principles of resuscitation
    • Airway: pt may be incubated if there isn’t airway obstruction due to laryngeal oedema.
  2. Supportive management
    • Pain management
    • Intravenous lines and fluids
  3. Management of complications
29
Q

Name 3 management precautions that should be noted:

A
  1. Avoid induced emesis:- further exposes oesophagus to damage by corrosive agents.
  2. Avoid acid neutralization:- This causes an exothermic reacotion and further damage the oesophagus.
  3. Give antibiotics if there is perforation.
30
Q

Battery button ingestion is common in children, it gets lodged in the upper oesophageal sphincter. How will the child present?

A

The child will present with

  1. Drooling of saliva.
  2. Feeding difficulties.

It is very important to diagnose battery ingestion because the alkali in the battery leaks out of the device, causing corrosive injury to adjacent mucosa
- Perforation may even occur

31
Q

What does a battery button look like on an x-ray?

A

Note that on an x-ray, it may be confused for a coin, physician should look out for halo sign on A-P view.c

The battery has a rim on the periphery- halo

32
Q

How is an ingested button battery removed?

A

Endoscopic removal

33
Q

For patients that have ingested a button battery, what kind of nutritional support is offered?

A

Patients with severe injuries are fed with total parental nutrition until an alternative feeding route is established e.g. jejunostomy.

Patients with mild insignificant injuries may be allowed to feed enterrally.

34
Q

2 of the complications associated with corrosive injury include oesophageal strictures and perforation.
- Explain how these complications are managed:

A

Perforation:
This requires emergency surgery after resuscitation and stabilization of the patient

Oesophageal strictures:
Carefully guided Dilatations should be repeated until the adequate lumen size is achieved.

35
Q

One of the complications of sustaining a corrosive injury, is the development of oesophageal strictures, how is this complication managed?

A

Carefully guided Dilatations should be repeated until the adequate lumen size is achieved.
Should dilatations fail, the oesophagus is replaced with a section of the colon.
- The native oesophagus has a higher risk of malignancy
- It is thus removed to be replaced with a section of the colon

Surgery- UGIT (9 decks)

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