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GI > ESOPHAGEAL FOREIGN BODIES > Flashcards

ESOPHAGEAL FOREIGN BODIES Flashcards

1
Q

what is the most common site of foreign body impaction?

A

esophagus

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2
Q

where are foriegn bodies usually lodged in?

A

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

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3
Q

what are the 3 most common causes (offenders)of impaction?

A
  1. food (steak, hot dogs, grapes, peanuts, candies)
  2. bones (fish)
  3. inedible objects (coins, batteries, magnets)
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4
Q

what type of impaction is most common in psych patients?

A

inedible objects- coins, batteries

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4
Q

what type of impaction is most common in kids?

A

food- peanuts

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5
Q

what are the 2 types of obstructions post- impaction?

A
  1. partial
  2. complete
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6
Q

what kind of obstruction is a medical emergency?

A

complete

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7
Q

why is a complete obstruction an emergency?

A

because of the risk for pressure necrosis or perforation

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8
Q

what are the 3 different types of complications with impactions?

A
  1. obstruction
  2. perforation
  3. infection
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9
Q

why can impaction cause infection?

A

because penetrating foreign bodies can lead to infection (retropharyngeal abscess)

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10
Q

what is the main presenting symptom of esophageal foreign body impaction?

A

dysphagia

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11
Q

what are the signs and symptoms of an esophageal foreign body impaction?

A
  1. dysphagia
  2. unable to swallow oral secretions (COMPLETE OBSTRUCTION)
  3. hypersalivation
  4. retrosternal fullness
  5. anxiety-> hyperventilation
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12
Q

what does dyspnea and auscultatory findings of stridor or wheezing indicate?

A

FB in the airway and not esophagus

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13
Q

what 2 imaging studies are done for FB’s?

A
  1. plain film x-rays (2 views)
  2. CT scan
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14
Q

what can plain film x-rays (2 views) detect?

A
  1. metallic foreign objects and bones
  2. signs of perforation (free air in the mediastinum or peritoneum)
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15
Q

what can a CT detect?

A
  1. objects not identifiable on plain film x-ray (wood, plastic, glass)
  2. dangerous ingestions (packets of illicit drugs)
  3. confirm and localize the FB prior to endoscopy
  4. Oral contrast SHOULD BE AVOIDED d/t
16
Q

what regarding CT should be avoided and why?

A

ORL CONTRAST d/t risk of aspiration and possible leakage of contrast with perforation

17
Q

if something is ingested and stuck at the proximal esophagus, what level is it at?

A

level of cricopharyngeus muscle (thoracic inlet) in line with the clavicles on x ray

18
Q

if something is ingested at the mid esophagus, waht level is it at?

A

level of aortic arch at the carina on x ray

19
Q

where is something ingested at the level of the lower esophageal sphincter seen?

A

2-4 vertebral levels above the gastric bubble on x-ray

20
Q

what is the management of an EMERGENCY complete esophageal obstruction?

A

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

21
Q

what is the management of an urgent obstruction?

A

-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

22
Q

what is the management of a non-urgent obstruction?

A
  • 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
23
Q

what are the 3 main treatments for food impaction?

A
  1. observation
  2. IV glucagon
  3. endoscopy
24
Q

why and how long would you decide to observe a food impaction for (tx wise)?

A

because many FB’s pass spontaneously into stomach
failure of partial obstruction to pass in 24 hours -> endoscopy

25
Q

whats the purpose of IV glucagon therapy for food impaction? bonus: whats dosage

A

it relaxes esophageal smooth muscle
- 1-2 mg IV, followed by 2 mg after 20 min if needed

26
Q

when would an endoscopy be performed?

A
  1. during high grade obstruction, ingestion of sharp objects, or disc/button batteries -> immediate therapeutic endoscopy
  2. advancement of the food bolus into the stomach
  3. removal

GI (22 decks)

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