There are three sites that are prone to caustic injury of the esophagus because of a relative delay in transit through the esophagus. Which are they?
- The three sites that are prone to caustic injury of the esophagus correlate to the anatomic narrowings of the organ and are:
- I. The proximal esophagus at the upper esophageal sphincter
- II. Mid esophagus where the aorta abuts the left mainstem bronchus.
- III. Distal esophagus just proximal to the lower esophageal sphincter.
Caustic injury of the esophagus occurs following ingestion of either strong acids or strong base chemicals (alkaline substances). Which chemicals cause more severe caustic injuries of the esophagus?
- Alkaline substances cause more severe caustic injury to the esophagus than the acids.
What is the mechanism of caustic injuries of the esophagus caused by acid substances?
- Acid substances cause coagulative necrosis forming an eschar that limits tissue penetration.
- In some cases, acid burns result in full-thickness injury, although in most cases, it is limited.
- Within 48 hours, the extent to which the acid will injure the esophagus is already determined.
What is the mechanism of caustic injuries of the esophagus caused by alkaline substances?
- Alkaline substances dissolve tissues by liquefactive necrosis deeply penetrating the tissues they touch.
There are two phases of caustic Esophageal injuries. Which are they and what is their gross pathology characteristic?
- There are acute and chronic phases in caustic esophageal injuries.
The acute phase is characterized by Esophageal necrosis.
The severity of esophageal necrosis depends on:
- ➀ Type of substance ingested
- ➁ Form of the substance
- ➂ Quantity and concentration of the substance ingested
- ➃ Amount of residual food in the stomach
- ➄ Duration of tissue contact.
The chronic phase of caustic ingestion focuses on subsequent structures and disruption of swallowing mechanism, which become significant problems several months after the injury.