Licensed books on medicine
<< Previous || Next >> |
Damage and foreign bodies of the esophagus
Damage to the esophagus is external and internal.
External, rarer ones include a breakthrough in the esophagus of abscesses of the lymph nodes, a tumor growing in it. Military injuries and incised wounds of the esophagus are possible in combination with damage to the pharynx and trachea. Internal damage - all cases of damage to the mucous membrane or the entire wall of the esophagus by foreign bodies, chemical agents, during medical manipulations, etc. External injuries are much less common than internal ones.
Combined wounds of the cervical esophagus are dangerous due to combined damage to large blood vessels, nerve trunks, spine, respiratory tract. Only in the absence of such combined lesions does a wounded person not die at the time of the injury. Symptoms of penetrating wounds of the esophagus are often poor. Violation of food and pain when swallowing are noted when the entrance to the esophagus is wounded; these symptoms are less pronounced with damage to its lower parts. The presence of such signs, along with the study of the direction and depth of the wound channel, make it possible to suspect and detect damage to the wall of the esophagus. The message of the esophageal wall defect with the wound is often detected after a patient swallows a sterile colored liquid (solutions of furatsilin, ethacridine lactate, etc.). However, if the defect in the esophagus does not gap or is displaced with respect to the wound canal, then the swallowed fluid may not leak into the wound. If there was no injury and bleeding in the upper respiratory tract, vomiting with blood indicates a wound to the esophagus. An X-ray examination of the esophagus confirms the presence of air or a contrast agent (iodolipol) in the peresophageal space. A wound to the esophagus is often accompanied by deep pain over the jugular notch, radiating to the sternum and back.
Treatment First of all, ingestion of food and saliva should be excluded. Massive doses of antibiotics are prescribed, as well as intravenous infusion of glucose solution (with the appropriate addition of insulin), vitamins, saline and protein solutions, a systematic toilet of the oral cavity, parenteral and rectal administration of fluid and nutrition are performed. Wound revision, if necessary, is usually done by approach through lateral pharyngotomy. A rubber tube is inserted into the esophagus through the natural pathway several days after the injury under the control of esophagoscopy. During this time, an infiltrative and edematous thickening of the edges of the wound will occur, which significantly reduces the possibility of infection from the esophagus, remove the probe after 2 weeks and prescribe non-coarse food. In case of signs of cicatricial narrowing of the esophagus, systemic prolapse should be performed. Treatment is carried out together with surgeons.
External damage to the esophagus is usually more severe than internal damage. This is due to the fact that with an external wound of the esophagus, saliva, food, vomit may enter the tissues surrounding the esophagus, i.e. in the mediastinum. Joining a secondary infection causes an extensive inflammatory process that affects the organs of the chest cavity and often leads to death. Existing trauma bleeding exacerbates the general condition of the patient. With a decaying tumor, fatal arrosive bleeding can occur.
Klinscheckartina depends on the nature of the external damage. In case of neck injuries near the esophagus without damage to the mucous membrane, symptoms of damage to the esophagus in the acute period may be absent, as well as with puncture wounds of the esophagus, since the edges of the opening in the mucous membrane can quickly stick together. Only within a few days the formation of the inflammatory focus will be manifested by such local symptoms as pain when swallowing, difficulty or inability to pass food, the appearance of saliva and food masses in the wound. Salivation and the appearance of food masses in the wound in the presence of a neck injury below the level of the cricoid cartilage is a reliable sign of injury to the esophagus. In addition, in all cases of a similar pathology there is dysphagia.
D and a g n about with t and to and in the presence of the above symptoms does not present difficulties. Indispensable studies confirming the penetrating trauma of the esophagus are fluoroscopy and contrast radiography with iodolipol.
Esophagoscopy plays a role, since when viewed through an esophagoscopic tube in each case, you can evaluate the nature of the local inflammatory process, and if necessary, suck the contents and treat the wound surface with medicinal substances.
Treatment usually includes surgical intervention: initial surgical treatment, suturing the wound, the introduction of a nasophageal probe for nutrition, as well as antibacterial and general anti-inflammatory treatment, which includes massive doses of antibiotics, sulfonamides, the introduction of hypersensitizing agents into the body, liquids etc. The therapy is carried out with periodic radiological and esophagoscopic control, which allows you to determine not only the size and shape of the injury, but also the dynamics of the process.
P rognog about external damage to the esophagus is heavy, but not unreliable; worse with infection of the mediastinum.
The most common causes of internal damage to the esophagus are injuries by foreign bodies and chemical burns.
Foreign bodies enter the esophagus most often with ingested food. It can be fish and meat bones, dentures, pieces of glass, coins, etc. Especially foreign bodies of the esophagus are found in adults. In those cases when a foreign body penetrates the mucous membrane of the esophagus or injures it, inflammation occurs at the site of the injury - esophagitis or periesophagitis due to the attachment of a secondary infection. Sometimes a foreign body, often a bone, damages not only the mucous membrane of the esophagus, but also the muscle layer, i.e. perforates the wall of the esophagus. In this case, a serious complication develops - mediastinitis. If the foreign body has smooth edges, it can pass into the underlying sections of the digestive tract without causing injury to the esophagus, or stop, more often in places of narrowing of the esophagus.
K l and n and with to and to kartin and. The patient’s complaints depend on the nature of the foreign body and the injury, on the duration of the disease and the location of the damage to the esophagus. Often with a foreign body, pain occurs when the head and neck move, aches and burning behind the sternum, pain when swallowing food or saliva, radiating to the back, etc. The general reaction of the body (fever, changes in blood and urine) is usually not expressed in the first period of the disease.
D and a gnost with t and to and is based on data from the anamnesis, indirect hypopharyngoscopy and radiography of the esophagus, including contrast. The latter method should be given special significance, since it allows not only to elucidate the nature of the foreign body, but also to clarify its localization and identify complications. At the same time, if a foreign body is not determined radiologically, then esophagoscopy or examination with a flexible fiber microscope (fiber optics) in this case solves the nature of the pathology or its absence; with its help produce therapeutic manipulations in the esophagus.
Treatment The foreign bodies of the esophagus are removed using esophagoscopy with x-ray control before and after the intervention. Esophagoscopy is performed under intubation endotracheal anesthesia for children. For adults, it can be performed under local anesthesia using a Brunings or Mezrin bronchoesophagoscope. In cases where esophagoscopy under local anesthesia is difficult for one reason or another, it is performed under endotracheal anesthesia. Blind pushing of foreign bodies of the esophagus into the stomach is unacceptable; this also applies to ingestion of crusts to push foreign bodies.
After removal of a foreign body in the presence of a mucosal injury, soft food is prescribed, anti-inflammatory and hyposensitizing therapy is carried out. If there is a perforation of the wall of the esophagus or suspicion of it, nutrition through the mouth is completely excluded, antibacterial and general anti-inflammatory treatment are prescribed, the patient is fed rectally and parenterally. The treatment of such a patient is the responsibility of thoracic surgeons.
P r about g n oz in the absence of complications favorable.
| << Previous || Next >> |
| = Skip to textbook content = |
Damage and foreign bodies of the esophagus
- Foreign bodies of the esophagus
The ingress of foreign bodies into the esophagus is random and the predisposing moments are considered in the description of the physiology of the esophagus. Foreign bodies linger in places of physiological constriction, most often (50 - 60%) - in the area of cricopharyngeal constriction, which has powerful striated muscles. The second place in the frequency of fixation of foreign bodies is in the thoracic region -
- FOREIGN BODIES IN THE FIELD OF THE MOUTH, THROAT, AND ESOPHAGUS
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
- 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
- FOREIGN BODIES AND DAMAGE TO THE THROAT
Foreign bodies fall into the throat when breathing or when swallowing and are countless diverse objects. The outcomes of a foreign body staying in the pharynx are different: it can be coughed up, expelled with an exhalation, spit out, lie freely in the pharynx without injuring the mucous membrane, advance further and become a foreign body of the larynx, trachea and bronchi, the esophagus, and finally, injure the mucous membrane and
- 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
- Injuries, foreign bodies of the esophagus, trachea and bronchus
Injuries, foreign bodies of the esophagus, trachea and
- Foreign bodies in the digestive tract
Esophagus obstruction 1. What is the most common cause of esophageal obstruction? At what level is obstruction more common? In most cases, foreign bodies (such as cartilage, fishing hooks) cause esophageal obstruction. Symptoms of obstruction can occur with stenosis and tumors of the esophagus. More often, obstruction occurs at the level of the base of the heart and lower sphincter of the esophagus. Foreign bodies in
- Alien bodies of the digestive tract
Foreign bodies of the pharynx Foreign bodies almost always enter the pharynx with food. Hasty food, lack of teeth, diseases of the masticatory apparatus, sudden cough, laughter, talking with food contributes to their ingestion. In addition, foreign bodies can enter the pharynx through the nose, as well as from the larynx and esophagus. Of particular danger are large foreign bodies. They are stuck in the larynx.
- Foreign bodies
Foreign bodies of the ear, nose, pharynx, and less commonly, the larynx, trachea, and bronchi, are more common. Foreign bodies of the ear are more common in children (paper, pencils, fruit bones), in adults - foreign bodies with sharp edges (fragments of matches) and insects. Rinsing with water is contraindicated during perforation of the tympanic membrane and complete obstruction of the lumen by a foreign body. Insects are killed before removal,
- Foreign bodies of the pharynx
Foreign bodies of the pharynx often come with food (fish and meat bones, glass fragments, pieces of wire, pieces of meat, lard). Foreign bodies can also be objects that accidentally fall into the mouth (pins, nails, buttons), dentures. Less common are living foreign bodies (leeches, roundworms). The ingestion of foreign bodies in the throat can be caused by such predisposing moments as fast food,
- ASPIRATION OF A FOREIGN BODY
Definition Foreign body aspirated into the respiratory tract. Etiology Foreign body aspirated by a child. Entry into the trachea of teeth displaced during manipulations in the upper respiratory tract. Surgical material remaining in the respiratory tract after surgery. Typical cases In children aged 7 months to 4 years: foreign body aspiration