Esophageal caustic burns
Introduction
Introduction to esophageal corrosive burns Esophageal corrosive burns, also known as esophageal corrosive injuries, are common in clinical practice. They are caused by esophageal injury and inflammation caused by swallowing corrosive agents. They can occur in children and adults. Corrosive agents are generally strong acids or alkalis. The latter are often household cleaners such as hydrogen. Sodium oxide, chlorine bleach. The reason for swallowing corrosive agents is that they are often misused in children. They are often over 5 years old. Adults are often swallowed for suicide. After swallowing liquid corrosive agents, they quickly pass through the esophagus. The main damage is often the lower esophagus and stomach. Solid corrosive type often leads to burns in the upper part of the mouth, pharynx and esophagus. Esophageal damage caused by strong acid and alkali is generally serious, which can cause esophageal mucosal erosion, necrosis, perforation, mediastinal inflammation, toxic shock, and even death. basic knowledge The proportion of sickness: 0.0020% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal perforation sepsis peritonitis
Cause
Causes of esophageal corrosive burns
(1) Causes of the disease
Esophageal Corrosion Injury Caused by esophageal injury and inflammation caused by swallowing corrosive agents, corrosive agents are generally strong acid or alkali, esophageal corrosive wounds are most common when swallowing alkaline corrosive agents, 11 times that of acidic corrosive agents, but when acid and alkali concentrations are high It can cause serious damage to the esophagus and stomach. The children and iodine mainly act on the mucosa, so there is less chance of stenosis.
(two) pathogenesis
The degree of corrosive damage of the esophagus is related to the type of corrosive agent, the dose, the concentration and the anatomical characteristics of the esophagus. The esophageal burns of strong acid and alkali are generally serious, which can cause mucosal congestion and edema. After 24 hours, the mucosa is eroded and tissue necrosis. If the whole esophagus is eroded, the esophagus is perforated, and an abscess around the esophagus is caused to cause a full mediastinal infection. The experiment confirms that the acid and alkali cause different pathological changes in the esophagus and stomach: the acidic corrosive agent can produce protein coagulative necrosis, usually superficial, less Erosion of the muscular layer, but can cause serious damage to the stomach, probably because the acidic corrosive agent can not be neutralized by gastric acid, the alkaline corrosive agent is more serious than the acidic one, and swallowing more than 60ml of strong alkali is enough to cause the patient to die. It can cause serious damage to the esophageal mucosa, which can cause protein solubilization, fat saponification, water absorption and tissue dehydration, and a large amount of heat in the dissolution process can also damage the tissue. If the burn area is wide and deep, prone to esophageal wall necrosis And perforation, the solid corrosive agent tends to adhere to the surface of the mucous membrane, the burn area is small, and the liquid rot The etchant enters the esophagus, and the contact area is wide and the damage is serious.
After swallowing the corrosive agent, the mouth, pharynx, esophagus and stomach can cause damage. In particularly serious cases, even the duodenum is damaged. Some children can still affect the face. Due to the reflux after swallowing, the glottis can be involved. Above, the severely damaged part is the three physiological narrow narrow areas of the esophagus. Generally, there are more chances of stenosis in the lower part of the esophagus than in the upper part, because the cardia is in a closed state, and the etchant stays here for a long time. After entering the stomach through the esophagus, it often causes vomiting, so the stomach content includes the corrosive agent to contact the esophagus again, which increases the degree of esophageal burn. Because the corrosive agent stays in the pyloric sinus for a long time, the scar healing after severe injury often leads to pyloric obstruction. Exploring whether the pyloric obstruction is merged, the stenosis formed by the corrosive agent is mostly scattered and extensive, and is irregularly distributed, so that the lumen is not on the same axis, so it is easy to cause mechanical damage and pores in the sheet.
The degree of esophageal and gastric corrosive burns can be divided into 3 degrees: once only involving the esophageal mucosa and submucosa, manifested as mucosal congestion, edema and epithelial shedding, because it does not involve the muscular layer, rarely causes scarring of esophageal stricture, after desquamation After 7 to 8 days, healed; second degree burn penetrated the mucosa and submucosa, involving the muscular layer, not involving the esophagus or stomach tissue, showing mucosal congestion, blisters, deep ulcers, pseudomembrane formation, later Granulation, so the esophagus loses its elasticity and peristalsis. Most of the esophageal scar stenosis occurs within 3 to 6 weeks. The third degree lesion involves the whole esophagus and the surrounding esophagus or surrounding tissues, and even the esophageal perforation. The inflammation can extend to the mediastinum or intra-abdominal organs. For the esophagus is extensive edema, occlusion of the lumen, carbonization and eschar, full-thickness necrosis, and perforation caused by mediastinal inflammation, can be due to major bleeding, sepsis, shock and death, survivors can produce severe stenosis.
Prevention
Esophageal corrosive burn prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Esophageal corrosive burn complications Complications esophageal perforation sepsis peritonitis
Esophageal perforation is a serious complication in the early stage after esophageal corrosive injury. Esophageal perforation is more common in the lower esophagus. Transverting the mediastinum can cause mediastinal inflammation. Penetrating into the chest can cause pneumothorax on one side or both sides. Patients have sepsis, shock, and difficulty breathing. Other symptoms, can also penetrate the trachea, causing esophageal tracheal fistula, stomach corrosion injury patients may have abdominal pain, upper abdominal tenderness, such as necrosis or perforation of the stomach wall, abdominal tenderness is more obvious, and abdominal muscle contraction and rebound pain, etc. Diffuse peritonitis, scarring of the esophagus and stomach is the main complication after the acute phase of burns.
Symptom
Esophageal corrosive burn symptoms Common symptoms Refusal to swallow dysphagia, coma, coma, swollen cheeks, burns, black stool, abdominal pain, difficulty breathing, wasting edema
Generally, swallowing corrosive agent immediately feels pain in the mouth, pharynx and sternum. It is especially obvious when swallowing. When the pain is severe, it can be radiated to the shoulder. When there is burn in the stomach, there may be upper abdominal pain. The patient refuses to eat due to swallowing pain, and the saliva increases. Vomiting occurs, vomit often mixed with bloody fluids, serious injuries appear, there may be high fever, coma, collapse and other poisoning phenomenon, a large number of swallowing strong acid, can still cause metabolic acidosis, a small number of patients due to glottic involvement or cause Reflux, accidentally attracting lung infections, can cause breathing difficulties and even cause suffocation.
Patients with corrosive injuries of the esophagus or stomach may have hematemesis or melena. In severe cases, they may die due to uncontrollable hemorrhage. A small amount of hematemesis may be caused by bleeding from the wound surface or necrotic tissue. A large amount of hematemesis or melena usually occurs 10 days after injury. Left and right, often caused by ulcer penetration into adjacent large blood vessels.
Dysphagia is a prominent manifestation of esophageal corrosive injury. It is often manifested as a saddle type. In the early post-injury, esophageal inflammatory edema can manifest different degrees of dysphagia. After 1 week, the symptoms of inflammatory edema gradually subsided, if the esophageal injury is not serious. Can not form scar stenosis, and gradually return to normal diet; such as severe esophageal burns, 2 weeks later due to fibrous connective tissue hyperplasia, scar contracture caused by stenosis, recurrence of dysphagia, and finally even the juice diet is difficult to swallow, leading to anemia, Weight loss, weight loss, malnutrition and other symptoms.
Examine
Esophageal corrosive burns
1. Esophageal X-ray swallowing examination
It is an important method for diagnosing esophageal corrosive injury. It is generally recommended that after the acute phase subsides, about 1 week after the injury, the approximate range of esophageal injury can be understood. It can be seen that the mucosa is irregular, local spasm, filling defect or stenosis, and esophageal perforation. Contrast agent contrast can be seen by iodine oil or water-soluble iodine preparation, and angiography should be performed regularly to evaluate the development of stenosis and treatment response.
2. Fiber esophagoscopy
The extent and location of esophageal injury can be directly observed. It is recommended to be performed 1 week after injury. At this time, granulation tissue is forming, and the risk of perforation is small. It is necessary to expand the treatment at the same time. However, many people have advocated 24~ Fiberoptic esophagoscopy was performed within 48 hours. This can be used to determine the severity of the injury at an early stage and make timely and correct treatments. It is not dangerous to have an experienced endoscopist to perform this test.
Diagnosis
Diagnosis and diagnosis of esophageal corrosive burns
Generally, the diagnosis can be made according to the history and clinical manifestations of the swallowing corrosive agent, and the dose, concentration, nature (acid or alkali) and cause (mistaken or attempted suicide) of the swallowing agent can be diagnosed to determine the severity of the damage. And treatment is helpful, patients who attempt suicide often take more doses of corrosive agents, the damage is very serious and extensive, the condition is also very serious, should closely observe the symptoms and signs, pay attention to vital signs and changes in consciousness, perforation of esophagus and gastric necrosis Be sure to diagnose as early as possible.
