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Burns of the pharynx and esophagus

Burns distinguish between thermal, chemical, electrical and radiation. Thermal burns of the oral cavity, pharynx and esophagus (often at the same time) usually occur when swallowing hot food, often liquid, sometimes when hot air, gas or steam gets into these cavities. In rare cases, only one organ is affected, which is associated with the duration of the contact of the damaging agent with the mucous membrane. More severe are usually chemical burns of the pharynx and esophagus, which occur when swallowing corrosive liquid poisons - concentrated solutions of acids and alkalis, taken accidentally or with a suicidal purpose. Burns of the pharynx and esophagus are often caused by acetic acid (essence), less often by caustic soda, ammonia, etc. When taking concentrated poison (more than 1-2 pharynx), death occurs within a few days due to intoxication and damage to the parenchymal organs, perforation of the stomach or esophagus due to deep necrosis of the walls of these organs, the transition of inflammation to the mediastinum, lung, and abdominal cavity.

Acids in contact with tissues take away the water of whitewash and denature them, as a result of which a dense scab forms. Alkalis, in contact with tissues, also take water from proteins and decompose them, saponify fats and penetrate deep into the tissue, forming a soft, loose scab. The deepest and most extensive lesions of the esophagus and stomach occur after an alkali burn. With thermal and chemical burns, 3 degrees of pathological changes in tissues are clinically distinguished: erythema (I degree), blistering (II degree) and necrosis (III degree).

Low concentrated solutions of acids and alkalis and weak thermal effects usually cause catarrhal inflammation (erythema) of the mucous membrane of the pharynx and esophagus, which usually ends in complete recovery without the formation of scarring changes. In cases where necrotic damage is limited to the mucous membrane, superficial adhesions, annular cicatricial folds occur that do not violate the elasticity of the entire wall. With necrosis of the muscle layer of the pharynx and esophagus, deep cicatricial changes in all layers of the organ wall are formed, as a result of which the elasticity and extensibility of the walls of the esophagus and pharynx are sharply limited. In such cases, extensive tubular stenosis occurs. Cicatricial changes in this case also extend to mediastinal fiber, which is always involved in inflammation with a deep burn of the esophagus wall.

The formation of the cicatricial structure usually ends in 1-2 months after the burn, however, in some patients this period can be significantly longer. Elements of inflammation in the form of swelling and infiltration sometimes persist for a long time in the wall of the esophagus after a burn, and after several months and even years can lead to scarring and narrowing of the esophagus. It should also be borne in mind that with aging, scar tissue dehydrates, compacts and contracts, thereby narrowing the lumen of the esophagus. Most often, cicatricial stenosis occurs behind the cricoid cartilage, at the level of the aorta in the supraphrenic section of the esophagus, i.e. in places of physiological constriction, where a reflex spasm in one way or another delays a poisonous fluid.

In most cases, post-burn cicatricial narrowing affects one section of the esophagus, however, multiple strictures are often found, between which undamaged sections of the esophagus are located. In the latter case, its lumen is not a straight line, but a broken line, which is important to keep in mind with esophagoscopy. Above the narrowed section of the esophagus, as a rule, an extension forms, the muscle walls of which first hypertrophy and then relax, after which the esophagus in this place becomes bag-like. In such a bag-like expansion of the esophagus, food accumulates and stagnates, its fermentation causes inflammation and ulceration of the mucous membrane, which can lead to perforation of the esophagus.

In the first few hours and days after a burn, Klinschakan is characterized by acute pain in the throat and along the esophagus, aggravated by swallowing and coughing. On the damaged mucous membrane of the lips, oral cavity, pharynx, extensive dense scabs are formed, white - with a thermal burn, acetic acid and alkali; yellow - with a burn of nitric acid; black and brown - with a burn of sulfuric and hydrochloric acids. If toxic substances enter the larynx, trachea, coughing and suffocation attacks occur. In some cases, a toxic substance can be roughly recognized by smell.

With burns of the first degree, only the superficial epithelial layer is damaged, which is rejected on the 3-4th day, exposing the hyperemic mucous membrane; the general condition of the patient suffers little. II degree burns cause intoxication, most pronounced on the 6-7th day during the period of rejection of necrotic deposits, leaving erosion. Since the thickness of the mucous membrane is damaged, the healing is granular with an outcome in the superficial scar. With the III degree of burn, the mucous membrane and underlying tissue are damaged at different depths, severe intoxication occurs. Scab rejection occurs by the end of the 2nd week, deep ulcers are formed, the healing of which lasts for several weeks, and sometimes months.
In this case, coarse deforming scars are formed, usually causing a narrowing of the esophagus.

Esophageal burns are often accompanied by complications such as laryngitis, tracheobronchitis, esophageal perforation, peresophagitis, mediastinitis, esophageal-tracheal fistula, pneumonia, sepsis, and exhaustion. In childhood, burns of I and II degrees cause extensive reactive processes in the form of swelling of the pharynx and larynx, an abundance of sputum, which causes significant respiratory failure due to stenosis in the throat and larynx.

D and a g n about with t and to and. You should rely on the detailed information from the medical history of the disease, subjective symptoms and data of the laryngoscopic and laryngoscopic picture. First of all, it is necessary to assess the general condition of the patient and the functions of life-supporting systems - respiratory, cardiovascular, renal, blood. Before rejection of plaque, esophagoscopy is dangerous. Compared with the pharynx, the esophagus is affected more severely, since the poisonous substance lingers in the esophagus longer due to its spasm at the time of the burn. Improving the condition of patients occurs at the end of the 2nd week after a burn. At this time, pain when swallowing disappears, existing ulcers begin to granulate, intoxication decreases or disappears. However, with a III degree burn, this is only an apparent improvement, since extensive granulation soon ends with the formation of stenotic scars, and by the end of the 2nd month there are signs of a delay in food or complete obstruction of the esophagus. Recognizing cicatricial narrowing of the esophagus on the basis of an anamnesis, clinical picture of the disease, X-ray data, fibroscopy and esophagoscopy, which is performed no earlier than the 10th day after the burn.

Treatment for burns of the pharynx and esophagus should begin as early as possible, best at the scene. With chemical burns, the poisonous substance is neutralized in the first 6 hours: if the burn is caused by caustic alkali, then the child or adult must be given one of the weak solutions of acetic, tartaric, or citric acid; if acid poisoning has occurred, sodium bicarbonate or magnesium oxide, chalk should be given in the solution. In case of a burn with caustic soda or ammonia, the stomach should be washed with a 0.1% solution of hydrochloric acid, and with a burn with acids, a 2% solution of sodium bicarbonate. In the absence of antidotes, water is used with the addition of half the volume of milk or raw egg proteins. Permissible gastric lavage with boiled warm water. If it is impossible to introduce a gastric tube, give 5-6 glasses of rinse liquid, then induce vomiting by pressing the tongue with a spatula or fingers. Rinsing with both methods should be repeated using 3-4 l of washing liquid. With thermal burns, the affected areas are lubricated with a 5% solution of potassium permanganate and a rinse with a pink solution of the same preparation is prescribed.

Along with the neutralization and leaching of toxic substances during second and third degree burns, anti-shock and detoxification measures are immediately shown: pantopone or morphine solution is injected subcutaneously, 5% glucose solution is injected intravenously, hemodesum, polyglucin solutions, plasma; cardiovascular and antibacterial drugs are used. If the patient can swallow, prescribe a sparing diet, drink plenty of water, give vegetable oil to be swallowed in small portions; if swallowing is not possible, rectal and parenteral nutrition is indicated.

In many cases, with burns of the pharynx, the entrance to the larynx is involved in the process; the swelling that occurs here can dramatically narrow the lumen of the larynx and cause asphyxiation. The presence of laryngeal edema is an indication for drug destenosis with the help of hypersensitizing drugs, prednisone, calcium chloride. In some cases, with the lack of effectiveness of these measures, delaying a tracheostomy can be dangerous due to the rapid development of severe stenosis of the larynx. It is advisable to administer antibiotics during the entire period of ulcer healing (1-2 months), which is the prevention of pneumonia and tracheo-bronchitis, prevents the development of infection on the wound surface and reduces subsequent scarring.

The most common method for reducing cicatricial stenosis of the esophagus during the recovery process is early bougieuding or leaving the nasophageal probe in the esophagus for a long time. Use probes wrapped in a specially prepared heterogeneous peritoneum or gauze soaked in a balsamic composition. 10-15 days after the burn, a contrast radiography of the esophagus is performed and, in the absence of aggravating factors, bougieurage. In order to reduce the growth of granulations and the formation of scars, steroid preparations, biostimulants, absorbable and antispastic therapy are prescribed simultaneously with bougienage. With the formed stenosis of the esophagus, causing its unsatisfactory patency and the impossibility of introducing the bougie, they make a gastrostomy and pass a thread through the narrowed esophagus into the stomach and gastrostomy, with which, first, thin and then thicker bougies are gently stretched through the gastrostomy and stomach, or plastic operation on the esophagus.
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Burns of the pharynx and esophagus

  1. Burns of the pharynx and larynx
    There are thermal and chemical burns. Thermal burns occur when exposed to hot liquids, vapors, gases. Chemical burns are more common. They are observed when swallowing acids and alkalis by mistake or with the aim of suicide. The most common burns are vinegar essence, ammonia and caustic soda. The degree of burn (from catarrh to necrosis) depends on
  2. Chemical burns of the esophagus
    Esophageal burns are usually of a chemical nature, with the exception of the rarest cases of thermal burns. Chemical burns of the esophagus occur with the accidental or deliberate (with suicidal purpose) intake of aggressive fluids inside. Currently, the most common cause of such burns is acetic essence (80% solution of acetic acid). The pathogenesis of a chemical burn of the esophagus is quite typical.
  3. Foreign bodies in the throat and esophagus
    Sometimes not only kittens, but also excessively curious adult cats swallow foreign objects. Some of these items are so small that they easily slip through the throat and esophagus, and then safely pass the stomach and intestines, and go out naturally, while others can get stuck. Often, for example, fish bones are stuck between the teeth, or stuck in the back of the throat
    The reasons for the entry of foreign bodies into the esophagus in dogs may be the habit of playing various objects and, hasty food, accidentally swallowing toys. In cats, the cause of foreign bodies (most often these are sewing needles with or without thread) is the special structure of the villi of the tongue. When trying to free itself from a randomly captured foreign body, a cat pushes it with tongue movements
  5. Diseases of the pharynx, esophagus and stomach
    Among the diseases of the pharynx and pharynx, angina, the infectious disease with the expressed inflammatory changes in the lymphadenoid tissue of the pharynx and palatine tonsils, has the greatest clinical significance. The following forms of acute angina are distinguished: catarrhal, lacunar, follicular, fibrinous, purulent, necrotic and gangrenous. In chronic tonsillitis, hyperplasia and lymphoid sclerosis occur.
  6. Diseases of the mouth, pharynx, esophagus
    Stomatitis (stomatitis) is an inflammation of the oral mucosa. All types of domestic animals are affected, but more often cattle and horses. By the nature of the inflammation, stomatitis is alternative, exudative and proliferative. Of the alternative ones, necrotic and ulcerative are most often found. Among the exudative, serous, catarrhal, purulent, fibrinous and, less often, hemorrhagic are distinguished
  8. Foreign bodies in the mouth, pharynx, larynx, trachea, esophagus, stomach and intestines
    Foreign bodies can be sharp, damaging and obstructing (clogging) the pharynx, larynx and esophagus. In case of suffocation, an urgent tracheotomy is necessary. The dog is fixed in the dorsal position, the hair is quickly removed from the ventral surface of the anterior third of the neck, twice the skin is lubricated with a 3% alcohol solution of iodine. Through a needle inserted strictly along the midline of the ventral surface
  9. Barrett's esophagus, adenocarcinoma of the esophagus
    There is no reliable data on the incidence of adenocarcinoma with Barrett's esophagus, but it is proved that the risk of the disease increases in this case by 20-40 times. Presumably, the mechanisms of carcinogenesis are similar to those in colon cancer - chronic damage to the epithelium and cell proliferation lead to genetic rearrangements and, ultimately, to the neoplastic process.
  10. Larynx burns
    Larynx burns are of two types - chemical and thermal. As a rule, they are combined with damage to the oral cavity, pharynx, and when swallowing a poisonous or hot substance, the esophagus (see "Burns of the pharynx and esophagus"). Chemical burns occur as a result of ingestion or inhalation of concentrated chemical solutions (acids, alkalis, etc.). Most often affected
  11. Esophageal stricture
    - narrowing of the esophagus associated with congenital or acquired factors Classification of cicatricial narrowing of the esophagus (G. L. Ratner, VI Belokonev, 1982) By etiology: burns with acids, alkalis, other burns By the time of obstruction: early (3-4 weeks), late (later than 1 month) According to the mechanism of development and clinical manifestations: A. Functional obstruction of the esophagus 1.
  12. Pharynx
    The pharynx is a funnel-shaped cavity with muscle walls, starting from the top from the base of the skull and passing below into the esophagus. The pharynx is located in front of the cervical spine. Its back wall is attached to the vertebrae, on the sides it is surrounded by loose connective tissue, and in front it communicates with the nasal cavity, oral cavity and larynx. According to the three cavities,
    The pharynx (pharinx) is an unpaired organ located in the head and neck, is part of the digestive and respiratory systems, is a funnel-shaped tube 12-15 cm long, suspended from the base of the skull. It is attached to the pharyngeal tubercle of the basilar part of the occipital bone, to the pyramids of the temporal bones and to the pterygoid process of the sphenoid bone; at the level of VI-VII cervical vertebrae
  14. Burns
    A burn is an injury that occurs when a body is exposed to high temperature, aggressive chemicals, electric current, and ionizing radiation. Burned is a person who has suffered a thermal injury. The frequency of burns is 5-10% of the total number of peacetime injuries. In the structure of burn injury, household burns prevail. A third of the number of burned are children.
  15. Clinical pharyngeal anatomy
    The pharynx (pharynx) enters the initial section of the digestive tract and respiratory tract. It is a hollow organ formed by muscles, fascia and lined with mucous membrane from the inside. The pharynx connects the nasal and oral cavities with the larynx and esophagus, through the auditory tubes the pharynx communicates with the middle ear. The pharyngeal cavity is vertically projected onto the bases of the occipital and wedge-shaped
    The pharynx has the following functions: swallowing, respiratory, protective, resonant, speech. The swallowing function (according to Magendie) is provided by two acts. Initially, with the approach of a food lump or saliva, the muscles of the amygdala arches (m. Palatoglossus et palatopharyngeus) and the muscles of the root of the tongue contract, pushing the contents further from the oral cavity to the oropharynx. The back muscles are included here.
  17. Burns
    Clinical characteristics of burns in children Burns are injuries to the skin and other tissues that occur under the influence of a thermal, chemical, electrical or radiation agent. Depending on the depth of the lesion, the following degrees of tissue damage in children are distinguished: 1) burns of I degree - damage to the upper layers of the epidermis, redness and swelling of the skin, pain in the area of ​​damage; 2) burns II
  18. Burns
    Burns (burnio) - damage to body tissues resulting from local effects of high temperature, chemicals, electric current or ionizing radiation. On the etiological basis, thermal, chemical, electrical and radiation burns are distinguished. Thermal burns are I-IV degrees. A degree I burn, or superficial burn, is characterized by the appearance of pain
    The pharynx, pharynx, is the initial part of the digestive tube located between the oral cavity and the esophagus. At the same time, it is also part of the respiratory tube, connecting the nasal cavity or oral cavity with the larynx. Consequently, in the pharyngeal cavity, the digestive and respiratory tract cross. The pharynx has the shape of a funnel-shaped tube flattened in the anteroposterior direction,
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