If a patient has been taking chemicals;
consumption of it, such as drain cleaners.
You might have to ask the patient.
But injury by alkali,
more so than acids.
Alkali is much more dangerous in terms of the way
that the chemical then affects the esophagus.
You’re going to cause full thickness burn, liquefactive
necrosis, with the caustic ingestion of alkaline agent.
Do not induce vomiting
by… after lye ingestion.
The vomiting actually
worsens the burn.
That is a huge management point there.
Once again, do not induce
vomiting after lye ingestion.
It just makes matters worse, because
now the patient is literally
exogenously introducing damage internally to the esophagus.
You can expect there to be
strictures taking place.
Stricture formation is common,
may be prevented by getting in there with
endoscopy and then dilating your esophagus
maybe perhaps by placing a stent.
3 to 4 weeks after ingestion.
You’ll want to wait a little bit because the
patient is going to be in quite a bit of pain.
Caustic ingestion; alkaline agents.
Complications: with the full thickness
being involved here,
and with the liquefactive, you’re worried
about chest… well, perforation.
And hence the chest X-ray becomes very, very crucial
for you to closely examine a patient after you
know there’s a history of caustic ingestion, because
if that esophagus ruptures, your patient’s dead!
So that is a big deal
here with perforation.
Risk factor here, remember now,
with caustic ingestion, and you’re
thinking more along the lines of
alkaline, much more so than acid.
And with the stricture formation, and with
persistent irritation, dysplasia and the type of
cancer that the patient would most likely develop
would be squamous cell cancer of the esophagus.
Versus reflux which would then first undergo metaplasia,
then may then develop dysplasia and adenocarcinoma.