Oesophageal tears Flashcards
What are oesophageal tears?
Ruptures to any part of oesophageal wall
What are the mortality rates of full oesophageal tear ruptures?
50-80%
What are the main two types of oesophageal tears?
Superficial mucosal tears (mallory-weiss tears) and full thickness ruptures
What happens in oesophageal perforation?
leakage of stomach contents into the mediastinum and pleural cavity which triggers a severe inflammatory response, causing multi-organ failure and death
What causes oesophageal perforation?
iatrogenic (endoscopy) and severe forceful vomiting
Where is the most common site of oesophageal perforation?
just above the diaphragm in the left postero-lateral position position
What are the common clinical features of oesophageal perforation?
sudden retrosternal chest pain, respiratory distress, subcutaneous emphysema following severe vomiting or retching
What initial investigations would you do?
routine bloods and a group and save as will need blood, CXR will show pneumomediastinum, CT chest abdomen pelvis with IV and oral contrast will show air or fluid in the mediastinum and pleural cavity, may need endoscopy in surgery
What is the management for oesophogeal perforation
resuscitation, control leak (on table OGD and leak and wash out of chest), eradicate contamination, decompress oesophagus, nutritional support
What is the non-operative treatment for oesophageal perforation?
initial suitable resuscitation and transfer to intensive care, antibiotics and antifungals, Nil by mouth for 1-2 weeks, NG TUBE, Large bore chest drain insertion, total parenteral nutrition
What is a Mallory Weiss tear?
lacerations in the oesophageal mucosa usually at the gastro-oesophageal junction that usually occur after lots of vomiting,
What is the management for Mallory Weiss tear?
same as any other upper GI bleed, conservative management
