Notes in Chapter 26

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Published	11/02/2024	Embryologically, the esophagus and trachea develop from the {{c1::foregut}}.
Published	11/02/2024	The esophagus and trachea are separated by the formation of {{c1::lateral longitudinal tracheoesophageal folds}} by {{c2::7 weeks}} of gestation.
Published	11/02/2024	The esophagus lacks a distinct {{c1::serosa}} layer.
Published	11/02/2024	The mucosa of the esophagus is lined by {{c1::nonkeratinizing}}, {{c2::stratified squamous epithelium}}.
Published	11/02/2024	The upper third of the esophagus is primarily composed of {{c1::striated muscle}} fibers.
Published	11/02/2024	The middle third of the esophagus comprises mixed {{c1::striated}} and {{c2::smooth muscle}} fibers.
Published	11/02/2024	The lower third of the esophagus contains only {{c1::smooth muscle}} fibers under {{c2::autonomic control}}.
Published	11/02/2024	The {{c1::mucosa}} is the strongest layer of the esophageal wall.
Published	11/02/2024	The upper esophageal sphincter (UES) consists of the {{c1::cricopharyngeus}} and {{c2::inferior pharyngeal constrictors}}.
Published	11/02/2024	The blood supply to the proximal esophagus is derived from the {{c1::fourth branchial arch}}.
Published	11/02/2024	The thoracic esophagus is supplied directly from branches of the {{c1::aorta}}.
Published	11/02/2024	The abdominal esophagus has a generous vascular supply from the {{c1::phrenic branches}} and {{c2::gastric vessels}}.
Published	11/02/2024	Lesions of the upper esophagus are best approached through the {{c1::right chest}} to avoid the {{c2::aortic arch}}.
Published	11/02/2024	The esophagus courses in the {{c1::posterior mediastinum}} posterior to the {{c2::trachea}}.
Published	11/02/2024	The separation of the esophagus and trachea is complete by {{c1::7 weeks}} of gestation.
Published	11/02/2024	The length of the esophagus is {{c1::8–10 cm}} at birth and doubles in the first {{c2::few years}} of life.
Published	11/02/2024	The esophageal wall is composed of four layers: {{c1::mucosa}}, {{c2::submucosa}}, {{c3::muscularis propria}}, and {{c4::adventitia}}.
Published	11/02/2024	The muscularis propria contains the inner {{c1::circular}} and outer {{c2::longitudinal muscle}} layers.
Published	11/02/2024	The submucosa contains the {{c1::venous}} and {{c2::lymphatic plexuses}}.
Published	11/02/2024	The upper third of the esophagus is under {{c1::voluntary}} control.
Published	11/02/2024	The {{c1::submucosal plexus}} of the proximal esophagus allows for extensive mobilization without vascular compromise.
Published	11/02/2024	Lesions of the lower esophagus can be explored through either the {{c1::right}} or {{c2::left chest}}.
Published	11/02/2024	To expose the distal esophagus via the left chest, the {{c1::inferior pulmonary ligament}} must be divided.
Published	11/02/2024	The inferior pulmonary vein runs in the upper part of the {{c1::pulmonary ligament}}.
Published	11/02/2024	The blood supply to the cervical esophagus comes from the {{c1::inferior thyroid artery}}.
Published	11/02/2024	Meticulous approximation of the esophageal mucosa is essential for a {{c1::technically sound anastomosis}}.
Published	11/02/2024	The {{c1::superior vena cava}} must be patent when the azygos vein is divided.
Published	11/02/2024	The {{c1::lower esophageal sphincter}}  is a physiologic sphincter controlling passage into the GI tract.
Published	11/02/2024	During the fourth week of gestation, the foregut endoderm differentiates into a {{c1::ventral respiratory}} part and a {{c2::dorsal esophageal}} part.
Published	11/02/2024	The proximal esophagus has an excellent {{c1::submucosal plexus}} allowing for extensive mobilization.
Published	11/02/2024	The thoracic esophagus is supplied by branches of the {{c1::aorta}}.
Published	11/02/2024	The abdominal esophagus is supplied by the {{c1::phrenic branches}} and {{c2::gastric vessels}}.
Published	11/02/2024	Lesions of the upper esophagus are best approached through the right chest to avoid the {{c1::aortic arch}}.
Published	11/02/2024	The azygos vein should be ligated and divided where it crosses the {{c1::esophagus}}.
Published	11/02/2024	The {{c1::mucosa}} retracts when the esophagus is divided.
Published	11/02/2024	The muscularis mucosa contains {{c1::longitudinal smooth muscle}} fibers.
Published	11/02/2024	The mucosa of the esophagus is lined by {{c1::nonkeratinizing}}, {{c2::stratified squamous epithelium}}.
Published	11/02/2024	The middle third of the esophagus contains mixed {{c1::striated}} and {{c2::smooth muscle}} fibers.
Published	11/02/2024	The lower third of the esophagus contains only {{c1::smooth muscle}} fibers under {{c2::autonomic}} control.
Published	11/02/2024	The upper esophageal sphincter (UES) consists of the {{c1::cricopharyngeus}} and {{c2::inferior pharyngeal constrictors}}.
Published	11/02/2024	The separation of the respiratory and esophageal parts occurs by the formation of {{c1::lateral longitudinal tracheoesophageal folds}}.
Published	11/02/2024	The muscularis propria of the esophagus consists of an inner {{c1::circular}} layer and an outer {{c2::longitudinal}} layer.
Published	11/02/2024	The upper third of the esophagus is primarily composed of {{c1::striated muscle}} fibers.
Published	11/02/2024	The mucosa of the esophagus is the {{c1::strongest layer}} of the esophageal wall.
Published	11/02/2024	The structure and function of the esophagus can be assessed with radiographic contrast studies, {{c1::manometry}}, and {{c2::endoscopy}}.
Published	11/02/2024	A barium esophagogram provides anatomic information regarding {{c1::mechanical obstruction}}, stricture, leak, and {{c2::extrinsic compression}} from …
Published	11/02/2024	A barium esophagogram provides functional information regarding peristalsis, {{c1::LES relaxation}}, and the presence/absence of {{c2::GER}}.
Published	11/02/2024	{{c1::Manometry}} is the gold standard for evaluating {{c2::motility disorders}}.
Published	11/02/2024	Diagnostic esophagoscopy is frequently used to evaluate {{c1::dysphagia}} and {{c2::gastroesophageal reflux}}.
Published	11/02/2024	{{c1::Flexible endoscopy}} is the technique of choice for routine diagnostic esophagoscopy.
Published	11/02/2024	The {{c1::rigid esophagoscope}} is more versatile and provides a larger diameter for better visualization and biopsies.
Published	11/02/2024	The rigid esophagoscope does not require air insufflation, important in the setting of {{c1::trauma}}.
Published	11/02/2024	Rigid esophagoscopy is mainly used for therapeutic procedures such as dilation of an esophageal {{c1::stricture}} or removal of a {{c2::foreign body}}…
Published	11/02/2024	Rigid esophagoscopy requires general anesthesia with {{c1::endotracheal intubation}} and {{c2::muscle relaxation}}.
Published	11/02/2024	In rigid esophagoscopy, the child is positioned supine with a roll under the shoulders to {{c1::extend the neck}}.
Published	11/02/2024	The esophagoscope is introduced into the oral cavity along the hard and soft palates to identify the {{c1::cricopharyngeus}} muscle and enter the esop…
Published	11/02/2024	Endoscopy with a flexible scope can be performed under {{c1::sedation}} or {{c2::general anesthesia}}.
Published	11/02/2024	The flexible endoscope is passed through the {{c1::pharynx}} and {{c2::cricopharynx}} into the upper esophagus.
Published	11/02/2024	The endoscope should never be advanced {{c1::blindly}}.
Published	11/02/2024	If the lumen is not apparent, the scope should be withdrawn slightly with gentle {{c1::insufflation}} until the lumen is identified.
Published	11/02/2024	Once the stomach is entered, it can be insufflated to allow inspection of the {{c1::mucosa}}.
Published	11/02/2024	Overdistention of the stomach in small infants may lead to {{c1::respiratory distress}}.
Published	11/02/2024	Complications related to passage of a rigid or flexible endoscope are typically at the level of the {{c1::cricopharyngeus}} muscle.
Published	11/02/2024	Congenital esophageal stenosis is a rare childhood condition with an incidence of 1 in {{c1::25,000–50,000}} live births.
Published	11/02/2024	One-third of patients with congenital esophageal stenosis have {{c1::EA}}.
Published	11/02/2024	The three histopathologic variants of congenital esophageal stenosis are {{c1::tracheobronchial remnants}}, {{c2::membranous diaphragms or webs}}, and…
Published	11/02/2024	Most infants with congenital esophageal stenosis have normal physical findings at {{c1::birth}}.
Published	11/02/2024	Symptoms of congenital esophageal stenosis typically develop with the introduction of solid food at ages {{c1::4–10 months}}.
Published	11/02/2024	Common symptoms of congenital esophageal stenosis include {{c1::vomiting}}, {{c2::dysphagia}}, and failure to thrive.
Published	11/02/2024	An esophagogram may show an abrupt or tapered stenosis at the junction of the {{c1::middle}} and {{c2::distal third}} of the esophagus.
Published	11/02/2024	When associated with EA, the stenosis is usually found in the {{c1::distal one-third}} of the esophagus.
Published	11/02/2024	{{c1::Endoscopic ultrasonography}} should be performed to evaluate for tracheobronchial remnants.
Published	11/02/2024	Balloon dilation has a success rate of approximately {{c1::90–95%}} in treating congenital esophageal stenosis.
Published	11/02/2024	Stenosis due to {{c1::tracheobronchial remnants}} responds less well to dilation, with a higher rate of perforation.
Published	11/02/2024	Patients who fail to respond to dilation should undergo limited resection of the stenosis through the {{c1::left chest}}, either open or thoracoscopic…
Published	11/02/2024	The onset of symptoms for congenital esophageal stenosis is rarely diagnosed in the {{c1::neonatal period}}.
Published	11/02/2024	Additional workup for congenital esophageal stenosis includes esophagoscopy with biopsy and {{c1::pH impedance}}.
Published	11/02/2024	Limited resection of the stenosis should be followed by primary {{c1::end-to-end anastomosis}} for long-term relief.
Published	11/02/2024	Congenital esophageal duplication is a rare anomaly with an incidence of 1 in {{c1::8000}} births.
Published	11/02/2024	Congenital esophageal duplication accounts for {{c1::10–15%}} of all GI duplications.
Published	11/02/2024	Histologic criteria for congenital esophageal duplication include attachment to the esophagus, enclosure by two {{c1::muscle layers}}, and lining by {…
Published	11/02/2024	Patients with esophageal duplication tend to present with respiratory symptoms, {{c1::vomiting}}, regurgitation, and, rarely, a neck mass.
Published	11/02/2024	Diagnosis of esophageal duplication can be made by {{c1::contrast esophagography}}.
Published	11/02/2024	{{c1::Neurenteric cysts}} can communicate with the spinal cord and require MRI to define the anatomy.
Published	11/02/2024	Operative resection is the treatment of choice for esophageal duplication because it may {{c1::increase in size}} and compress surrounding structures.
Published	11/02/2024	The duplication can be approached via a posterolateral {{c1::thoracotomy}} or {{c2::thoracoscopy}}.
Published	11/02/2024	Operative guidelines for esophageal duplication include preserving the {{c1::vagus}} and {{c2::phrenic}} nerves.
Published	11/02/2024	After resection of esophageal duplication, the muscular wall of the esophagus should be {{c1::reconstructed}}.
Published	11/02/2024	Air insufflation of the esophagus intraoperatively can be done with endoscopy or a {{c1::nasogastric tube}} to assess the integrity of the esophageal …
Published	11/02/2024	Diagnosis of esophageal duplication can be confirmed by {{c1::contrast esophagography}}.
Published	11/02/2024	Neurenteric cysts require {{c1::MRI}} to define the anatomy.
Published	11/02/2024	After resection, air insufflation is used to assess the {{c1::integrity}} of the esophageal wall.
Published	11/02/2024	Achalasia is a chronic motility disorder characterized by absent or poor esophageal {{c1::peristalsis}} and failure of the LES to {{c2::relax}} during…
Published	11/02/2024	The specific etiology of achalasia is {{c1::unknown}}.
Published	11/02/2024	Achalasia is rare in children, with an incidence of 0.11 cases per {{c1::100,000}}.
Published	11/02/2024	Achalasia has been associated with syndromes including {{c1::trisomy 21}}, congenital hypoventilation syndrome, and {{c2::Chagas disease}}.
Published	11/02/2024	Presenting symptoms of achalasia in infants include frequent {{c1::regurgitation}}, choking, pneumonia, and failure to thrive.
Published	11/02/2024	Older children with achalasia present with dysphagia, regurgitation, retrosternal {{c1::chest pain}}, and weight loss.
Published	11/02/2024	Due to its rarity, achalasia is commonly misdiagnosed as {{c1::GER}}, leading to delayed diagnosis.
Published	11/02/2024	Barium esophagography for achalasia shows aperistalsis, a {{c1::dilated esophagus}}, and minimal or no opening of the LES, known as the “{{c2::bird’s …
Published	11/02/2024	Esophageal manometry is the standard diagnostic test for achalasia, showing elevated LES {{c1::pressure}}, failure of the sphincter to relax with swal…
Published	11/02/2024	There is no cure for the underlying pathology of achalasia; treatment aims to reduce the LES pressure to facilitate {{c1::esophageal emptying}}.
Published	11/02/2024	The Eckardt score is used to quantify symptoms of achalasia, with a normal score being ≤{{c1::3}}.
Published	11/02/2024	Pharmacologic treatment for achalasia with nitrates or calcium channel blockers provides a {{c1::short-lived}} decrease in LES pressure.
Published	11/02/2024	Intersphincteric injection of {{c1::Botulinum toxin}} (Botox) creates a chemical denervation by inhibiting the release of acetylcholine.
Published	11/02/2024	Botox treatment for achalasia has a high {{c1::recurrence}} rate, limiting its applicability in children.
Published	11/02/2024	Pneumatic dilation involves forceful dilation of the LES with a balloon dilator of {{c1::30–35 mm}} in older children.
Published	11/02/2024	Immediate relief of symptoms is expected following pneumatic {{c1::dilation}}, but symptoms may recur around {{c2::6 months}}.
Published	11/02/2024	The perforation rate with pneumatic dilation is about {{c1::5%}}, which can be managed conservatively or with immediate operative repair.
Published	11/02/2024	Esophagomyotomy disrupts the muscularis propria of the LES without penetrating the {{c1::esophageal}} or gastric mucosa.
Published	11/02/2024	The technique favored by most surgeons for esophageal myotomy is an extended laparoscopic esophagomyotomy (Heller myotomy [LHM]) with partial {{c1::fu…
Published	11/02/2024	The esophageal myotomy should be extended 4–6 cm {{c1::above}} and 2–3 cm {{c2::distal}} to the gastroesophageal junction.
Published	11/02/2024	Intraoperative techniques for esophageal myotomy include endoscopy and {{c1::manometry}} to assess mucosal integrity and adequacy.
Published	11/02/2024	Recent reports show excellent outcomes after LHM with partial fundoplication, with symptom resolution in {{c1::85–100%}} of patients.
Published	11/02/2024	Significant {{c1::reflux}} develops in 9–17% of patients after LHM, usually managed with medications.
Published	11/02/2024	Intraoperative mucosal perforation occurs in {{c1::5–30%}} of cases and is typically managed by covering the perforation with an anterior fundoplicati…
Published	11/02/2024	Reintervention rates for recurrent symptoms are higher in {{c1::children}} than in adults, with 15–25% requiring postoperative balloon dilations or re…
Published	11/02/2024	Persistence or recurrence of dysphagia following myotomy is thought to be due to incomplete disruption of the muscle fibers of the {{c1::distal esopha…
Published	11/02/2024	Esophagomyotomy has been used to effectively treat achalasia in {{c1::infants}}.
Published	11/02/2024	Infant achalasia is thought to have a different {{c1::natural history}} than achalasia in older children.
Published	11/02/2024	Some favor nonoperative management for infant achalasia, using {{c1::Botox}} or temporary {{c2::gastrostomy}}.
Published	11/02/2024	Peroral endoscopic myotomy (POEM) is an emerging technique for an extended esophagomyotomy performed {{c1::endoscopically}}.
Published	11/02/2024	In POEM, the submucosal plane is entered in the proximal esophagus with a {{c1::flexible endoscope}}, creating a distal submucosal tunnel.
Published	11/02/2024	The extended myotomy in POEM is performed using an endoscopic {{c1::knife}} and cautery, with the mucosal defect closed with {{c2::clips}}.
Published	11/02/2024	Outcomes of POEM are similar to LHM with partial {{c1::fundoplication}}, with dysphagia relief approaching {{c2::100%}} and reflux developing in 11–46…
Published	11/02/2024	A recent series reported 100% of patients symptom-free at {{c1::24 months}} following POEM.
Published	11/02/2024	Complications of POEM include mucosal injury at the myotomy site ({{c1::18%}}), pneumothorax requiring chest tube placement ({{c2::7%}}), and pneumope…
Published	11/02/2024	POEM is performed by relatively few pediatric surgeons due to the requirement for specialized {{c1::endoscopic equipment}} and expertise.
Published	11/02/2024	Treatment for achalasia is {{c1::palliative}}, not {{c2::curative}}.
Published	11/02/2024	Even after operative intervention for achalasia, children have significantly lower quality of life (QOL) scores than those with {{c1::inflammatory bow…
Published	11/02/2024	Population-based studies show a 16-fold risk of developing {{c1::esophageal cancer}} following treatment for achalasia.
Published	11/02/2024	The absolute risk of esophageal cancer remains relatively low, and there is no consensus on the need for routine {{c1::surveillance}} in these patient…
Published	11/02/2024	Foreign body ingestion is common in {{c1::children}}, with potential life-threatening complications.
Published	11/02/2024	Foreign body impaction in the esophagus is most likely at the cricopharyngeus of the UES, the {{c1::aortic notch}}, the left mainstem bronchus, and th…
Published	11/02/2024	In Western countries, {{c1::coins}} account for most pediatric foreign body ingestions, while pieces of food account for 10–20%.
Published	11/02/2024	Infants with foreign body ingestion may present with excessive drooling, refusal to eat, and unexplained {{c1::coughing}}.
Published	11/02/2024	Older children with foreign body ingestion can have dysphagia, vomiting, chest pain, or {{c1::respiratory symptoms}}.
Published	11/02/2024	Initial diagnostic tests for esophageal foreign bodies include anteroposterior and lateral chest {{c1::radiographs}}.
Published	11/02/2024	A coin in the esophagus is best seen on the {{c1::anteroposterior view}}, while in the trachea, it is best seen on the lateral view.
Published	11/02/2024	Radiographs can differentiate coins from button batteries, which may show a {{c1::halo sign}} and step-off between positive and negative nodes.
Published	11/02/2024	If no radiopaque object is seen, a {{c1::contrast esophagram}} or diagnostic endoscopy can be performed.
Published	11/02/2024	Key principles of endoscopic management include protecting the airway, maintaining control of the object during {{c1::extraction}}, and avoiding addit…
Published	11/02/2024	Flexible endoscopy is often used to remove low-risk (smooth-surfaced) esophageal foreign bodies, with coins grasped and extracted with {{c1::endoscopi…
Published	11/02/2024	About 40–50% of pediatric esophageal food impactions are associated with {{c1::eosinophilic esophagitis}}.
Published	11/02/2024	Endoscopic removal of esophageal foreign bodies should be followed by biopsy, treatment with a {{c1::proton pump inhibitor}}, and repeat endoscopy in …
Published	11/02/2024	Rigid esophagoscopy under general anesthesia is the gold standard for removing foreign bodies or complicated presentations, with low {{c1::complicatio…
Published	11/02/2024	Foreign bodies causing perforation into nonvascular structures should be managed with positioning an endoscopic feeding tube, NPO, and {{c1::IV antibi…
Published	11/02/2024	Button batteries can cause severe complications, including esophageal perforation and aortoesophageal {{c1::fistula (AEF)}}.
Published	11/02/2024	Lithium button batteries >20 mm cause injury through caustic injury due to {{c1::hydroxide radicals}}.
Published	11/02/2024	Management of button battery ingestion includes emergent removal with rigid esophagoscopy and noting the orientation of the {{c1::negative pole}} on r…
Published	11/02/2024	Risk factors for severe complications of button battery ingestion include esophageal impaction at the aortic arch, age <5 years, battery size of ≥2…
Published	11/02/2024	Aortoesophageal fistula (AEF) has a fatality rate of 40–70%. Patients with hematemesis should undergo {{c1::emergent CT angiography}} to evaluate the …
Published	11/02/2024	Emergent endoscopic removal of foreign bodies near the aorta should be performed with {{c1::cardiothoracic surgeons}} available for aortic control and…
Published	11/02/2024	Post-removal, evidence of injury within 3 mm of the aorta requires prolonged NPO, IV antibiotics, and serial {{c1::chest MRI}}.
Published	11/02/2024	Aortoesophageal fistula can also present weeks after seemingly uncomplicated removal of an esophageal {{c1::button battery}}.
Published	11/02/2024	Esophageal perforation is a rare but life-threatening event in children, commonly resulting from {{c1::iatrogenic}} causes such as stricture dilation,…
Published	11/02/2024	Other causes of esophageal perforation include foreign body ingestion, caustic ingestion, infection, or {{c1::trauma}}.
Published	11/02/2024	The most common locations of esophageal perforation are the {{c1::pharyngoesophageal junction}} in neonates and the thoracic esophagus in older childr…
Published	11/02/2024	Full-thickness esophageal perforations lead to leakage of bacteria and digestive enzymes into the cervical soft tissues, mediastinum, pleural space, o…
Published	11/02/2024	Symptoms of thoracic esophageal perforations include chest pain, respiratory distress, dysphagia, fever, or {{c1::subcutaneous emphysema}}.
Published	11/02/2024	After an endoscopic or esophageal dilation procedure, any symptomatic child should be evaluated for esophageal {{c1::perforation}}.
Published	11/02/2024	The initial diagnostic test for esophageal perforation is a chest radiograph in {{c1::anteroposterior and lateral}} views.
Published	11/02/2024	Radiographic findings suggestive of esophageal perforation include pneumothorax, pleural effusion, subcutaneous emphysema, pneumopericardium, or {{c1:…
Published	11/02/2024	A {{c1::contrast esophagram}} is the diagnostic study of choice to confirm esophageal perforation.
Published	11/02/2024	CT of the chest with intravenous contrast may increase sensitivity for detecting esophageal perforation and can show pneumomediastinum, pleural effusi…
Published	11/02/2024	Nonoperative management of esophageal perforation includes making the patient NPO, starting broad-spectrum {{c1::antibiotics}}, and possibly placing a…
Published	11/02/2024	Contained perforations with extravasation that drain back into the esophagus often heal with {{c1::supportive care}} only.
Published	11/02/2024	If contrast extravasates into the pleural space, {{c1::tube drainage}} is required to create a controlled fistula.
Published	11/02/2024	Operative management is needed for abdominal esophageal perforations with peritoneal cavity communication, extensive contamination, or clinical {{c1::…
Published	11/02/2024	Primary repair of esophageal perforations is best within the first {{c1::24 hours}} after the perforation occurs, using absorbable sutures and reinfor…
Published	11/02/2024	If tissues are too inflamed to hold sutures, wide drainage and distal feeding access should be performed, with cervical esophagostomy being primarily …
Published	11/02/2024	Emerging treatments for esophageal perforations in adults include covered {{c1::stents}} and endoluminal vacuum therapy, but data in children is limit…
Published	11/02/2024	The morbidity and mortality of esophageal perforation is directly related to the delay in {{c1::diagnosis}} and treatment.
Published	11/02/2024	There is a fivefold increase in complications following a delay in diagnosis of greater than {{c1::24 hours}}.
Published	11/02/2024	The mortality rate of esophageal perforation in the pediatric population is {{c1::4%}}, which is lower than that reported for adults.
Published	11/02/2024	Caustic or corrosive substances are chemical agents capable of injuring tissue on {{c1::contact}}.
Published	11/02/2024	Caustic ingestion is especially common in children <{{c1::6 years old}}}} and is a global problem, particularly in developing countries.
Published	11/02/2024	In 20–40% of caustic ingestions, some degree of {{c1::esophageal injury}} will be produced.
Published	11/02/2024	The extent of caustic injury depends on factors including the {{c1::composition}} of the substance, volume, concentration, and duration of contact.
Published	11/02/2024	Acidic injuries result in immediate pain and {{c1::coagulative necrosis}} with eschar formation, which limits tissue penetration and injury depth.
Published	11/02/2024	Acidic ingestions most commonly cause {{c1::gastric injury}}.
Published	11/02/2024	Alkali ingestions more commonly result in {{c1::esophageal injury}} due to liquefactive necrosis and saponification.
Published	11/02/2024	Alkali ingestions lead to vascular {{c1::thrombosis}}, which impedes blood flow to the damaged tissue.
Published	11/02/2024	Granular products can cause more serious injuries due to prolonged contact time with the {{c1::esophageal mucosa}}.
Published	11/02/2024	Alkali ingestions have three phases of injury: liquefactive necrosis, {{c1::reparative phase}}, and scar retraction.
Published	11/02/2024	During the {{c1::liquefactive necrosis}} phase, injury rapidly penetrates the deep layers of the esophagus until the alkali is buffered by tissue flui…
Published	11/02/2024	The reparative phase occurs between {{c1::5 days and 2 weeks}} following injury and includes sloughing of necrotic debris and development of granulati…
Published	11/02/2024	Scar formation begins after {{c1::2 weeks}} and may result in esophageal stricture formation.
Published	11/02/2024	Following caustic ingestion, patients may present with symptoms such as nausea, vomiting, dysphagia, odynophagia, drooling, abdominal pain, chest pain…
Published	11/02/2024	Initial management after caustic ingestion should focus on {{c1::airway management}}, volume resuscitation, and evaluation for perforation.
Published	11/02/2024	Inducing {{c1::emesis}} is discouraged as it can increase mucosal damage from additional exposure to the substance.
Published	11/02/2024	There is no evidence to support {{c1::dilution therapy}} with water or milk following caustic ingestion.
Published	11/02/2024	Chest and abdominal radiographs should be obtained to look for signs of perforation, and a {{c1::contrast esophagram}} is the diagnostic study of choi…
Published	11/02/2024	Flexible upper endoscopy should be performed within the first {{c1::24–48 hours}} after ingestion to assess the degree of injury, except when perforat…
Published	11/02/2024	Endoscopy is generally not performed after {{c1::5 days}} due to increased risks of perforation, fistula, and bleeding in the burned esophagus.
Published	11/02/2024	Caustic injuries are classified based on endoscopic evaluation into first-degree, second-degree, and {{c1::third-degree}} injuries.
Published	11/02/2024	First-degree injuries are superficial and result in edema and {{c1::erythema}}, but no stricture formation.
Published	11/02/2024	Second-degree injuries involve the mucosa, submucosa, and muscle layers, resulting in deep ulceration, granulation tissue, and potential stricture for…
Published	11/02/2024	Third-degree injuries are transmural with deep ulcerations, resulting in a {{c1::black appearance}} to the lining of the esophagus.
Published	11/02/2024	The risk of complications increases ninefold with each incremental increase in injury {{c1::grade}}.
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