Oesophageal emergencies Flashcards
(55 cards)
What is the risk of perforation after routine OGD?
0.01-0.03%
OGD stands for oesophagogastroduodenoscopy.
What is the risk of perforation after oesophageal dilatation?
0.5-3%
What percentage of spontaneous perforations is accounted for by Boerhaave’s syndrome?
15%
Boerhaave’s syndrome involves spontaneous rupture due to forceful vomiting.
What percentage of perforations are caused by foreign bodies?
14%
Foreign bodies can cause trauma leading to perforation.
What are the two classifications of oesophageal perforation based on time?
Early vs late, < 24 hrs vs >24 hrs
What is the most common cause of oesophageal perforation?
Iatrogenic
Responsible for over 50% of cases, primarily in the distal oesophagus.
What procedures are most associated with iatrogenic perforation?
- Dilation (specifically in achalasia and strictures)
- Stenting
- Interventional endoscopy (EMR, Phototherapy)
Diagnostic procedures are less likely to cause perforation but can occur due to underlying abnormalities.
What is Boerhaave’s syndrome?
Spontaneous rupture due to forceful vomiting
It is typically associated with some unrecognized anatomical or pathologic abnormality.
What are the two types of trauma that can cause oesophageal perforation?
- Penetrating
- Blunt
Penetrating trauma includes gunshot wounds and stabs, while blunt trauma can come from foreign bodies.
What is the pathology associated with spontaneous rupture?
50% associated with GORD
GORD increases the chance of high intragastric pressure affecting the thoracic oesophagus.
What is Mackler’s triad for spontaneous rupture?
- Vomiting
- Chest pain
- Subcutaneous emphysema
What is Hamman’s sign?
Mediastinal crunch with heartbeat
Suggests mediastinal emphysema.
What is the most common site of spontaneous perforation?
Left posterolateral thoracic oesophagus 3-5cm above GOJ
What are some differential diagnoses for chest pain related to perforation?
- Myocardial Infarction (MI)
- Pneumonia
- Pericarditis
- Pneumomediastinum
- Spontaneous pneumothorax
What laboratory findings may indicate oesophageal perforation?
Elevated inflammatory response, serum amylase may be elevated
Serum amylase may rise if saliva has extruded due to perforation.
What are typical radiological findings in oesophageal perforation?
- Pleural effusion
- Pneumomediastinum (40%)
- Subcutaneous emphysema
- Hydropneumothorax
- Pneumothorax
- Collapse/consolidation
Plain films may show subtle findings and can be normal in up to 10% of cases.
What is the first choice imaging modality in stable patients suspected of having oesophageal perforation?
CT scan
IV contrast is sensitive, but oral water-soluble contrast is the gold standard.
What is the role of endoscopy in the diagnosis of oesophageal perforation?
Useful to exclude diagnosis and identify underlying lesions
It can be performed in theatre with patients intubated if unstable.
What are the risks associated with endoscopy in cases of perforation?
Risk of insufflation of perforation and worsening injury
Caution is advised during this procedure.
What is the initial step in the management of oesophageal rupture?
Initial resuscitation, ABCS, large bore IV access
This includes controlling the airway and providing supplemental oxygen.
What is the purpose of IV PPI in the management of oesophageal rupture?
Prevent further injury from acidic gastric secretions
What is the role of an NGT in the management of oesophageal rupture?
Decompress stomach, limit reflux into oesophagus
What is the nutritional support recommendation for patients with oesophageal rupture?
Strictly NBM
.
when should TPN be considered in oesophageal rupture management?
if ileus
TPN provides nutrition intravenously.
