ESOPHAGEAL FOREIGN BODIES Flashcards
what is the most common site of foreign body impaction?
esophagus
where are foriegn bodies usually lodged in?
lodged in areas of physiologic or pathologic luminal narrowing such as:
- sphincters (UES and LES)
- strictures
- tumors
- previous surgery-> adhesions
- underlying disorder/disease such as achalasia, eosinophilic esophagitis
what are the 3 most common causes (offenders)of impaction?
- food (steak, hot dogs, grapes, peanuts, candies)
- bones (fish)
- inedible objects (coins, batteries, magnets)
what type of impaction is most common in psych patients?
inedible objects- coins, batteries
what type of impaction is most common in kids?
food- peanuts
what are the 2 types of obstructions post- impaction?
- partial
- complete
what kind of obstruction is a medical emergency?
complete
why is a complete obstruction an emergency?
because of the risk for pressure necrosis or perforation
what are the 3 different types of complications with impactions?
- obstruction
- perforation
- infection
why can impaction cause infection?
because penetrating foreign bodies can lead to infection (retropharyngeal abscess)
what is the main presenting symptom of esophageal foreign body impaction?
dysphagia
what are the signs and symptoms of an esophageal foreign body impaction?
- dysphagia
- unable to swallow oral secretions (COMPLETE OBSTRUCTION)
- hypersalivation
- retrosternal fullness
- anxiety-> hyperventilation
what does dyspnea and auscultatory findings of stridor or wheezing indicate?
FB in the airway and not esophagus
what 2 imaging studies are done for FB’s?
- plain film x-rays (2 views)
- CT scan
what can plain film x-rays (2 views) detect?
- metallic foreign objects and bones
- signs of perforation (free air in the mediastinum or peritoneum)
what can a CT detect?
- objects not identifiable on plain film x-ray (wood, plastic, glass)
- dangerous ingestions (packets of illicit drugs)
- confirm and localize the FB prior to endoscopy
- Oral contrast SHOULD BE AVOIDED d/t
what regarding CT should be avoided and why?
ORL CONTRAST d/t risk of aspiration and possible leakage of contrast with perforation
if something is ingested and stuck at the proximal esophagus, what level is it at?
level of cricopharyngeus muscle (thoracic inlet) in line with the clavicles on x ray
if something is ingested at the mid esophagus, waht level is it at?
level of aortic arch at the carina on x ray
where is something ingested at the level of the lower esophageal sphincter seen?
2-4 vertebral levels above the gastric bubble on x-ray
what is the management of an EMERGENCY complete esophageal obstruction?
this means that there is an inability to handle oral secretions since its a complete obstruction
disk batteries in the esophagus
sharp-pointed objects in the esophagus
what is the management of an urgent obstruction?
-within 12-24 hours you treat
- food impactions w/o complete obstruction**
- sharp-pointed objects in the stomach and duodenum
- objects >6cm in length above the duodenum
- multiple magnets (Or single magnet plus another ferromagnetic object within endoscopic reach)
- coins in esophagus
what is the management of a non-urgent obstruction?
- objects in stomach >2.5 cm diameter
- disk battery in stomach up to 48 hours if asymptomatic
- blunt objects that fail to pass stomach in 3-4 weeks
what are the 3 main treatments for food impaction?
- observation
- IV glucagon
- endoscopy
why and how long would you decide to observe a food impaction for (tx wise)?
because many FB’s pass spontaneously into stomach
failure of partial obstruction to pass in 24 hours -> endoscopy
whats the purpose of IV glucagon therapy for food impaction? bonus: whats dosage
it relaxes esophageal smooth muscle
- 1-2 mg IV, followed by 2 mg after 20 min if needed
when would an endoscopy be performed?
- during high grade obstruction, ingestion of sharp objects, or disc/button batteries -> immediate therapeutic endoscopy
- advancement of the food bolus into the stomach
- removal
