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Esophageal emergencies

Esophageal emergencies. esophagus. 20-25 cm muscular tube posterior and lateral to trachea Upper third is striated, then smooth muscle Three constrictions in adults C6 (cricopharyngeous muscle) resting pressure here at UES is 100 mm Hg T4 (aortic arch)

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Esophageal emergencies

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  1. Esophageal emergencies

  2. esophagus • 20-25 cm muscular tube posterior and lateral to trachea • Upper third is striated, then smooth muscle • Three constrictions in adults • C6 (cricopharyngeous muscle) resting pressure here at UES is 100 mm Hg • T4 (aortic arch) • T11 (GE junction) resting pressure at LES is 25 mmHG

  3. dysphagia • Is there odynophagia? • Is it just solids (mechanical or obstructive) or liquids and solids (motility disorders) • Is there a foreign body sensation?

  4. Structural and obstructive causes • Neoplasms • Esophageal stricutre • Schatzki’s ring • intermittent dysphagia with solids • Esophageal webs • Zenker’s diverticulum

  5. Motor lesions • Neuromuscular disorders • CVA • Polymyositis and dermatomyositis • Achalasia • Impaired relaxation of the lower sphincter • Impaired esophageal peristalsis • Diffuse esophageal spasm

  6. Causes of GERD

  7. treatment • H2 blockers • PPIs • Avoiding caffeine, alcohol, smoking, fatty foods and eating within 3 hours of bed.

  8. Esophageal perforations • Most spontaneous perforations occur through the left posterolateral wall of the distal esophagus • Pain is acute, severe, unrelenting, and diffuse • CXR and chest CT • Hamman’s crunch – mediastinal air moved by the beating heart.

  9. Esophageal perforation • Boerhaave syndrome • full-thickness perforation after a sudden rise in intraesophageal pressure • Sudden, forceful emesis, commonly seen after alcohol • Trauma • Penetrating > blunt • Foreign body ingestion

  10. Esophageal foreign body • Children: usually proximal locations • Adults: usually distal impactions • If FB makes it past pylorus, most will pass • Endoscopy for diagnosis/treatment • Can try glucagon (smooth muscle relaxer)

  11. Special situations • Food impaction • Coin ingestion • Can try foley catheter removal technique • Button battery • Sharp objects • Need removed is still in stomach or duodenum • Narcotics • Packers cannot undergo endoscopy due to risk of perforation, which could be fatal

  12. references • Tintinalli, Ch. 80

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