This document discusses foreign bodies and chemical burns of the esophagus. It outlines the signs and symptoms, which include pain, dysphagia, and dyspnea. Diagnostic findings may include identifying the foreign body on x-ray. Treatment involves endoscopy and removal devices. Bougienage procedures use dilators to facilitate passage. Chemical burns are often caused by swallowing acids or bases and result in inflammation that can cause strictures requiring dilation or even esophagectomy and colon interposition.

1. Foreign bodies and chemical burns of
the esophagus
Presented by ;
v.ramya,
Tutor.

2. objectives
 The students will be able to
 -introduce esophageal foreign bodies and chemical burns
 -signs and symptoms of esophageal foreign bodies and
chemical burns
 -diagnostic findings of esophageal foreign bodies and
chemical burns
 - management of esophageal foreign bodies and chemical
burns

3. introduction
 Many swallowed foreign bodies pass through the
GI tract without the need for medical
intervention.
 However ,some swallowed foreign bodies (e.g.,
dentures ,fish bones ,pins ,small batteries ,items
containing mercury or lead ) may injure the
esophagus or obstruct its lumen and must be
removed .

4. Upper esophageal foreign body ( coin )

5. SIGNS AND SYMPTOMS
Pain and
 Dysphagia may be present
Dyspnea may occur as a result
of pressure on the trachea.

6. DIAGNOSTIC FINDINGS
The foreign Body may be
identified by X – Ray .

7. X -RAY

8. DIAGNOSTIC FINDINGS
Glucagon, because of its relaxing effect on
the esophageal muscle, may be injected IV.
A flexible endoscope and retrieval devices
(e.g ., forceps ,graspers) may be used to
remove the impacted food or object from
the esophagus.

9. Foreign bodies
 Foreign bodies such as short – blunt objects ,
 Long objects,
 Sharp – pointed objects ,
 Disc batteries,
 Magnets ,
 Coins,
 Or narcotic packets require special consideration.

10. bougienage procedure
 For example , dilation techniques such as bougienage
procedure can be used to facilitate the passage of
foreign objects.
 In bougienage ,cylindrical rubber tubes of different sizes
called bougies, are advanced in to the esophagus via the
oral cavity
 The dialator can manually advance the foreign object.
 The procedure usually is performed in the endoscopy
suite or clinic by the gastroenterologist.

11. bougienage procedure

12. Chemical burns

13. Chemical burns
 Chemical burns of the esophagus occur most
often when a patient , either intentionally ( 67 %
; typically adults ) or unintentionally (33 %
typically children ) , swallows a strong acid or
base , with alkaline agents being the most
common.
 The patient is often emotionally distraught as
well as in acute physical pain.

14. causes
Chemical burns of the esophagus may
also be caused by undissolved
medications in the esophagus ,or they
may also occur after swallowing a
battery , which may release a caustic
alkaline

15. Acute chemical burn
 An acute chemical burn of the esophagus may
accompanied by
 Severe burns of the lips ,mouth and pharynx,
 With pain on swallowing.
 Breathing difficulties due to either edema of the throat
 Or a collection of the mucus in the pharynx may occur.

16. Signs and symptoms
The patient ,who may be profoundly toxic ,
Febrile,
And in shock , is treated immediately for
shock,
Pain and
Respiratory distress.

17. Diagnostic findings
Esophagoscopy and barium swallow are
performed as soon as possible to determine
the extent and severity of damage .
Vomiting and gastric lavage are avoided to
prevent further exposure of the esophagus
to the caustic agent.

18. esophagoscopy

19. Barium swallow

20. Surgical management
Emergent esophagectomy or
gastrectomy may be required.
The patient remains NPO and
IV fluids are given.

21. esophagectomy

22. Colon interposition

23. Colon interposition

24. Medical management
The use of corticosteroids to reduce
inflammation and minimize subsequent
scarring and stricture formation is of
questionable value.
Antibiotics are prescribed if there is
documented infection.

25. Nutritional management
After the acute phase has
subsided , the patient may need
nutritional support via enteral or
parenteral feedings.

26. dilators
 The patient may require further treatment to prevent or manage
strictures of the esophagus .
 Dilation of the bougienage may be sufficient , but may need to be
repeated periodically
 Progressively larger bougies are used to dilate the esophagus.
 Some strictures requires rigid dilators , such as savary dilators .
 These dilators are used in the same fashion as bougies but may be
more successful for opening difficult strictures.

27. rigid dilator

28. savary dilator

29. reconstruction
 For strictures that do not respond to either method of
dilation , surgical management may be necessary.
 Reconstruction may be accomplished by esophagectomy
and colon interposition.
 To replace the portion of esophagus removed.
 This surgery is quite complex and should be considered
only when other options have failed.

30. bibliography
 Brunner and Suddarth’s Textbook of Medical- Surgical Nursing
,South Asian Edition , Volume 1 , Published by Wolters Kluwer .
Page reffered to 849 -854.
 Ansari and Kaur, Textbook of Medical – Surgical Nursing 1 .
Published by Pee Vee 2011 Edition, Page reffered to 850 – 852.
 https://www.slideshare.net/rajinderdhaliwal92/f-b-esophagus
 https://www.slideshare.net/drpradeeppande/foreign-body-
oesophaguspptx-254455016
 https://www.webmd.com/first-aid/chemical-burns