Esophageal Perforation And Varices Flashcards
Boerhaave syndrome……….?
Spontaneous esophageal rupture (Boerhaave syndrome) is less common and is associated with sudden increases in intraesophageal pressure wrought by situations such as vomiting, coughing, or straining at stool.
Boerhaave syndrome site of perforation…..?
In older children, as in adults, the tear occurs on the distal left lateral esophageal wall, because the smooth muscle layer here is weakest;
in neonates (neonatal Boerhaave syndrome), spontaneous rupture is on the right.
Signs of perforation
Signs of perforation include pneumomediastinum, mediastinal widening, subcutaneous emphysema, pneumothorax, hydrothorax, pleural effusion, and lung collapse.
Pressure for varices……?
Esophageal varices form in adults with portal hypertension with hepatic venous pressure gradient above 10 mm Hg and pose a risk for bleeding at above 12 mm Hg
uphill varices; vs downhill varices
Most esophageal varices are uphill varices; less commonly, those that arise in the absence of portal hypertension and with superior vena cava obstruction are downhill varices.
Any child with hematemesis and splenomegaly should be presumed to have
Esophageal variceal bleeding until proved otherwise
The leading causes of pediatric portal hypertension…….?
Biliary atresia, and extrahepatic portal vein obstruction
Primary prophylaxis for varices……?
Primary prophylaxis with the goal of preventing an initial hemorrhage can decrease the incidence of esophageal bleeding; the various modalities used are nonselective β blockade (e.g., propranolol or nadolol), sclerotherapy, ligation, and portosystemic shunt surgery.
Bypass surgery choice in case of EHPVO…..
MesoRex bypass surgery should be offered to children with EHPVO as both primary and secondary prophylaxis in the appropriate context
Treatment for refractory varices ….?
Transjugular intrahepatic portosystemic shunt should be considered for variceal bleeding refractory to medical and endoscopic therapy
