Vince Mkotta
39 statements · 1 topic
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Some that get lodged high at the cricopharyngeus. If it's high in the esophagus, it's going to be where the aorta crosses over. That's not too common, and even less common is Rare vascular anomalies like subclavians, but more commonly if it's in the esophagus, typically it's at the lower esophageal sphincter where we end up going in and retrieving most foreign bodies.
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Ingestion of Foreign Bodies
if there is a strong concern, especially if it was a witness, uh, esophageal button battery, um, we treat those as emergencies and take them, you know, within 2 hours to the operating room for removal.
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Ingestion of Foreign Bodies
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Vince's statements about Ingestion of Foreign Bodies 39 statements
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Digestive Foreign Bodies: Diagnosis and Management
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Esophageal foreign bodies most commonly lodge at three locations: high at the cricopharyngeus, where the aorta crosses over (less common), and at the lower esophageal sphincter (most common retrieval site).
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Quotation
Some that get lodged high at the cricopharyngeus. If it's high in the esophagus, it's going to be where the aorta crosses over. That's not too common, and even less common is Rare vascular anomalies like subclavians, but more commonly if it's in the esophagus, typically it's at the lower esophageal sphincter where we end up going in and retrieving most foreign bodies.
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The most common age group is probably the just mobile. Infants through toddler age range, so maybe like 6 months to 6 years.
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The most common age group for foreign body ingestion is 6 months to 6 years (just mobile infants through toddler age range).
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Foreign body ingestion can occur in very young infants, such as when a toddler tries to feed an infant.
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Many patients who swallow small objects never reach specialists because pediatricians appropriately recognize the object is likely to pass in asymptomatic children.
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If, if it's an esophageal foreign body, we're still more likely than not to go after it
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Children with esophageal foreign bodies may present with odynophagia (pain with swallowing), intolerance of secretions and drooling, pointing to one spot on their throat, vomiting after trying to swallow, chest pain, or refusal to eat.
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Physical examination findings are usually unremarkable in children with ingested foreign bodies.
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The classic teaching that coins in the esophagus appear coronal and coins in the airway appear sagittal on X-ray is not always the case according to published evidence.
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For radiolucent objects in asymptomatic patients with strong suspicion, a contrast study may be performed if nothing is seen on plain X-ray, though contrast can make endoscopic retrieval more difficult.
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if you remember the classic teaching of coins in the esophagus, you're going to see in coronal and then coins in the airway, you're going to see sagittal, well, there's good published evidence that says that that's not always the case
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Initial imaging for suspected foreign body ingestion should be a two-view abdomen and chest X-ray.
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Workup for eosinophilic esophagitis is warranted when there is family history of the condition or frequent food impactions, strong atopic history (food allergy, asthma, severe eczema, rhinitis), or when objects that should pass easily become lodged.
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button batteries uh change our change our evaluation, um, pathway considerably. You know, that's, that's, that's probably the biggest and most common need for emergent removal.
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Button batteries are the biggest and most common need for emergent removal of ingested foreign bodies.
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On X-ray, button batteries classically show a double-edged sign with a step-off, especially on lateral view, though this may not always be visible depending on how long the battery has been present.
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Esophageal button batteries are treated as emergencies and should be removed within 2 hours in the operating room.
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if there is a strong concern, especially if it was a witness, uh, esophageal button battery, um, we treat those as emergencies and take them, you know, within 2 hours to the operating room for removal.
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When concerned about a button battery, imaging should include the whole neck and chest to rule out a more proximal battery that may have been cut off the film.
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I think many of us don't feel comfortable with that, um, and I think unfortunately here we've had several of us have had fatal gastric button battery ingestion. So I think myself and many of my colleagues, if we can get it, we will go and go get it immediately.
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For gastric button batteries in asymptomatic patients, guidance suggests they can sometimes be observed, but many practitioners retrieve them immediately due to fatal gastric button battery ingestions.
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If an esophageal coin has been lodged for 24 hours, it can cause significant problems.
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I think that the guidance is still, if it's, if it's in the esophagus for, you know, 24 hours, um, it can cause big problems.
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For short-duration asymptomatic esophageal foreign bodies, patients are frequently admitted overnight with repeat X-ray in the morning; if the object has not moved, it should be retrieved.
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Round gastric foreign bodies unlikely to cause injury in asymptomatic children can be observed and allowed to pass, with monitoring of stool.
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Relatively large foreign bodies (4 or 5 centimeters) in the stomach may not pass the pylorus and have higher likelihood of requiring retrieval.
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For sharp objects like nails or pins in the stomach, retrieval is attempted if reachable, but once beyond the stomach they are observed for symptoms rather than pursued.
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Single-sided sharp objects that reach the stomach generally pass through the GI tract without significant injury, with the theory that they flip and go blunt side down.
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If it is a, you know, one side of an object is sharp, and it's made it into the stomach, generally speaking, they actually make it through the through the GI tract without too much injury.
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very proximal, um, Esophageal foreign bodies are very difficult to get with a flexible scope. Um, and so having either surgery or ENT, um, go after it with a rigid scope is almost certainly preferable.
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Very proximal esophageal foreign bodies are very difficult to retrieve with a flexible scope and are preferably removed by surgery or ENT using a rigid scope.
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