pharynx and cheek burns
Introduction
Introduction Esophageal chemical burns, also known as acute corrosive esophagitis (acute corrosive esophagitis) is caused by strong acid, alkali and other chemical corrosive agents caused by serious damage to the esophagus, the first detection of pharyngeal cheek burns. The type, concentration and amount of corrosive agents are closely related to the severity of esophagitis.
Cause
Cause
Causes of swollen cheek burns
(1) Causes of the disease
Esophageal chemical burns are clinically classified into two types: acidic and alkaline corrosion. Acidic chemicals, such as strong acid (with sulfuric acid, nitric acid, hydrochloric acid, carbolic acid, etc.) can cause coagulative necrosis at the interface with the tissue. Because of the strong acid resistance of the mucus attached to the surface of the esophageal squamous epithelium, it can prevent acid from penetrating into deep tissues. Therefore, it can be absorbed into the stomach without being absorbed; alkaline chemicals such as potassium hydroxide, sodium hydroxide, lycopene, brine, dilute ammonia solution (ammonia) and lime water can dissolve protein, collagen and fat. After service, it mainly produces liquefied necrosis and penetrates into deep tissues, causing extensive tissue damage. Because of the high specific gravity, the liquid alkali easily enters the esophagus and stomach through the pharynx; the solid base is often confined to a certain area of the pharynx or esophagus because of its easy adhesion.
(two) pathogenesis
The esophageal injury and healing caused by alkaline substances are divided into three phases, namely the acute phase (days 1-4): liquefaction, necrosis, intravascular thrombosis and progressive inflammatory changes, mucosal congestion and edema. No mucosal shedding and necrosis occurred within 24 hours; subacute phase (5th to 14th day): mucosal detachment in necrotic area, formation of ulcer with granulation tissue, fibroblasts and collagen deposition began to appear, and the esophageal wall was thinner and easiest. Perforation; scar formation period (15 days to 3 months): fibrous tissue formation, further deposition of collagen, collagen contraction began at the third week, causing esophageal stricture. Regeneration of the esophageal mucosa is completed within 4 to 3 months after swallowing corrosive lye. The late complication of severe esophageal chemical injury is esophageal stricture, and the stenosis is mostly located in the most severe part of the esophageal injury. The physiological stenosis of the esophagus is likely to cause the corrosion of the substance to stay, and is the most severe part of the esophageal injury.
Examine
an examination
Related inspection
Nasopharyngeal MRI examination Eustachian tube examination
Examination of pharyngeal cheek burns
The early symptoms were salivation, vomiting, fever and swallowing pain and difficulty, pain in the back of the sternum and under the xiphoid. The symptoms disappeared after about 2 weeks, and the dysphagia occurred again in the late stage of burn (about 1 month later), and gradually increased. Trends, partial or complete esophageal obstruction. Can be complicated by cough, shortness of breath and respiratory aspiration pulmonary edema or infection.
Mainly rely on medical history, the first detection of pharyngeal cheek burns during physical examination, according to the degree of burn and the dose and traits of corrosive agents and the difficulty of swallowing to determine whether there is esophageal burn.
Complications after swallowing corrosive agents can be divided into local and systemic.
1. Systemic complications: If the amount of poison is high, there is a systemic poisoning phenomenon, and the severe ones die within a few hours or within 1-2 days.
2. Local complications
(1) Bleeding: A small amount of vomiting may occur within a few days after taking the poison, but a large amount of bleeding is caused by the shedding of necrotic tissue, which often occurs within 1 to 2 weeks. Generally, a large amount of bleeding suddenly occurs in about 10 days. Death due to unstoppable. Therefore, for severe patients, after all symptoms disappeared after 1 week, it is best to stay in bed and enter the fluid diet until 2 weeks, so that there is not much bleeding.
(2) esophageal perforation and mediastinal inflammation: only in patients with swallowed venom is too thick and large, generally alkaline corrosion is more likely to occur in the esophageal perforation, more at the lower end of the esophagus rupture to the left chest cavity, sometimes through to The trachea forms a tracheal esophageal fistula, and there have been reports of accidental rupture to the aortic arch in the literature.
(3) Gastric burn, gastric perforation and peritonitis: more complicated with acidic corrosive agents, showing acute abdominal symptoms and critical illness.
(4) laryngeal edema, aspiration pneumonia, lung abscess and bronchiectasis: can be complicated by acute corrosive esophagitis and scar stenosis, especially in children.
(5) esophageal scar stenosis: often an inevitable complication, only early prevention can prevent it, stomach scar stenosis is often complicated in patients swallowing acidic corrosive agents.
Diagnosis
Differential diagnosis
Congestive symptoms of pharyngeal cheek burns
Esophageal chemical burns are generally difficult to diagnose based on their medical history, symptoms, and signs, and often coexist with corrosive gastritis. However, in the clinic should pay attention to whether or not combined with other lesions of the esophagus.
For middle-aged and elderly men, it is especially important to distinguish between esophageal cancer and cancer. Esophageal cancer is mainly characterized by difficulty in swallowing and weight loss. The condition is progressively aggravated. X-ray and gastroscopy combined with biopsy can confirm the diagnosis.
