Corrosives

Question 1

What are Corrosives:

Answer 1

Substance which have local, rapid and destructive action on any tissues which come in contact with.

Question 2

Classification of corrosives with examples:

Answer 2

organic acids : oxalic, carbolic, and acetic acid
Inorganic acids:sulfuric, hydrochloric, and nitric
Alkalies: Sodium and potassium hydroxyl and ammonia

Question 3

other corrosive than acids and alkalies:

Answer 3

Salts: Hg chloride, Antimony trichloride
Potassium permanganate
Hydrogen peroxide

Question 4

Factors effecting severity of corrosives injury:

Answer 4

Concentration
Ammount ingested
Time of contact
Form of agent
Ph : alkalies >11.5-12 and acide <2 can cause serious injuries

Question 5

Most of the intentional digestion happens with:

Answer 5

Adult:
Adult exposure have more morbidity than childhood exposure because of significant volume and possibility of coingestion of other harmful agent

Question 6

Common acid containing sources

Answer 6

Toilet bowel cleaners
Rust removing products
Metal and cement cleaning products

Question 7

Common alkaline containing sources:

Answer 7

Drain cleaning products
Oven cleaning products
Swimming pool sanitizer
Automatic dishwasher detergents
Bleaches
Hair relaxes

Question 8

Pathophysiology of alkaline ingestion:

Answer 8

1. Liquefactive necrosis and saponifiation of fats 》 deep tissue destruction
2. Further injury by thrombosis of BV

Question 9

Alkalies most severely affect which part?

Answer 9

Squamous epithelium of the esophagus, but the stomach is also involved in 20% of cases

Question 10

Ingestion of liquid alkalis cause:

While ingestion of solid alkalis:

Answer 10

Multiple long strictures

Short dense strictures

Question 11

Acid ingestion cause tissue injury by:

Answer 11

Coagulation necrosis with the formation of coagulum and eschar

Question 12

Acids most commonly affect which part of GIT?

Answer 12

Stomach

The esophagus is affected in 6-20% of cases

Question 13

In the initial phase of the injury, the eschar may limit further penetration and control the extent of the injury:
Is this good?

Answer 13

Yes, but delayed sloughing of large surface area may lead to bleeding and frank perforation

Question 14

General clinical manifestations of corrosives:

Answer 14

1. Pharyngeal pain and dysphagia
2. Apparent erythema, edema erosion in the oropharynx, tongue lips, and mouth cavity.
3. Repiratory distress
4. Glottic and subglottig edema
5. Hypotension, tachycardia
6. Spesis may developed shortly after presentation

Question 15

Common acute complications of corrosives ingestion:

Answer 15

GIT hemorrhage
Perforation
Upper airways obstruction

Question 16

Common chronic complications of corrosives:

Answer 16

1. Esophageal obstruction secondary to stricture formation
2. Malnutrition, dehydration, and cachexia
3. Increased risk of esophageal carcinoma
4. Dermal burns due to scarring, poor healing, and infection

Question 17

Management of dermal exposure:

Answer 17

Remove contaminated clothes
Irrigation by tap water

Question 18

Management of eye exposure:

Answer 18

Copious irrigation with water

Question 19

Management of ingested caustic:

Answer 19

1. Induce emesis or neutralize substance is CI (You want to cure the alkalinity by pouring acid, you idiot?)
2. No signs of perforation? Dilution by water and milk
3. Corticosteroids

Question 20

Why do we use corticosteroids in the management of corrosives:

Answer 20

It may inhibit collagen formation in wound healing and decrease strictures.

Question 21

Occupational exposures are often more severe, why?

Answer 21

Because the industrial products are more concentrated.