Caustic Ingestion

6.2.1 Discuss Acids vs. Bases and types of injuries they cause in caustic ingestions. Understand that there are different types and concentrations of caustic agents.

6.2.2 List the typical signs and symptoms of caustic ingestion.

6.2.3 Describe the staging of esophageal burns in caustic ingestion.

6.2.4 Discuss the role of esophageal endoscopy in caustic ingestion. Why the controversy? Discuss the timing of endoscopy after a caustic ingestion.

6.2.5 Should we perform endoscopies on asymptomatic patients with caustic ingestion?

Gupta SK, Croffie JM, Fitzgerald JF. Is esophagogastroduodenoscopy necessary in all caustic ingestions? J Pediatr Gastroenterol Nutr. 2001 Jan;32(1):50-3. PMID:11176325

6.2.6 Present the pharmacologic treatment of esophageal burns after caustic ingestion. Discuss the role of antibiotics, antireflux medications, and steroids.

6.2.7 You are called to the ER for evaluation of a 2-year-old who has recently ingested ½ bottle of Drano. She is in no respiratory distress, but is crying and drooling. What do you do?

6.2.8 A 3 year old is seen in the laundry room taking a few sips of household bleach. He immediately coughs and spits it out. In the ED, he is in no distress and appears comfortable. There are no visible injuries in the mouth or oropharynx. What is the next step in management? Should this patient have an upper aerodigestive tract endoscopy in the OR?

6.2.9 Identify the most common complication of esophageal burns and discuss its proper management.

6.2.10 List other potential complications of caustic ingestions.

6.2.11 16 months after a caustic ingestion with lye in a suicide attempt, a 16-year-old girl is G tube dependent and unable to swallow by mouth. She has undergone several esophageal dilations, with no lasting improvement in her symptoms. She has a barium esophagram which is seen here. Discuss options for her management at this point.

http://portal.entnet.org/images/COCLIA/2011-2012%20updates/COCLIA%20Media/Caustic%20Ingestion/Caustic%20Injestion-Q11-Caustic1.jpg

6.2.12 Describe different techniques for dilation of strictures caused by caustic injury to the esophagus.

6.2.13 Discuss the management of button battery ingestion. (Also in Aerodigestive Foreign Bodies section of COCLIA)

6.2.14 What are strategies for prevention of caustic ingestions in children? What government policies are in place to help prevent caustic ingestions in children?