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home - Oesophagus - Miscellaneous - Foreign Bodies Written by Dr Sebastian Zeki
Nausea and Vomiting:
Understands the pathophysiology of vomiting.
Appreciates the gastrointestinal conditions that cause nausea and
vomiting as well as the range of extra-intestinal causes

Recognises the influence of neurological conditions and metabolic
derangements such as diabetes

Understands the physiology of gastric emptying and how this is
affected by disease, toxins and drugs

Abdominal Pain:
Knows the causes of acute and chronic abdominal pain that arise
from upper gastrointestinal, biliary and pancreatic diseases

Understands the clinical presentations of the various conditions
causing pain and the means by which they can be diagnosed and
treated

Weight Loss:
Knows the significance of weight loss as a consequence of upper
gastrointestinal disease, knows those conditions that present with
loss of weight and how they are managed

Skills
Makes a detailed clinical assessment of patients presenting with
symptoms indicating possible upper gastrointestinal disease,
construct a management plan and be aware of the various avenues
of treatment

Behaviours
Evaluates patients in a structured and timely manner, carries out
appropriate investigations and formulates management plan.

Foreign Bodies

Urgent endoscopy indications:Sharp objects (pins, partial dentures, fish bones, toothpicks)- these are most likely to perforate the oesophagus.Symptomatic patients, especially those who are unable to handle oral secretions.Patients with disc or button batteries lodged in the oesophagus in order to avoid local caustic injury and perforation. Narcotic packetsDon’t remove endoscpoically because of risk of rupture Long objectsLong objects (> 6 to 10 cm) are unlikely to pass the duodenal sweep and should be removed.Remove with overtube. Food bolusGive 1mg iv glucagon to relax oesophagus.Consider pushing bolus through if safe. BatteriesDisk batteries should be removed promptly. as can cause perforation.Use retrieval basket or net and overtube.If pass into stomach, will go through whole GI tract with no problem.Emetics are not useful.Cathartics and acid suppression are of unproven benefit, although cathartics may expedite passage.Batteries <15 mm in diameter almost never lodge in the oesophagus. Sharp pointed objects:Medical emergency. Complications develop in 35%.Remove with an overtube.If can’t remove endoscopically, need daily x-rays and surgery if not resolved in 3 days. Blunt objectsUse forceps ("rat-tooth" or "alligator"), a snare, or a retrieval net.Weekly radiographs are sufficient in asymptomatic patients. Surgery if stays in same position for >1 week. >2.5cm unlikely to pass 4 days to 4 weeks to pass Foreign bodies in the oesophagus in adults Blunt Objects Sharp and Long Objects Food, batteries and drugs Management No treatment is needed in the patient who presents with a history of a foreign body ingestion but is asymptomatic and has negative plain radiographs. Indications For Urgent Removal of Batteries:Batteries larger than 20 mm in diameter.Battery in the stomach for longer than 48 hours. Written by Dr Sebastian Zeki Under no circumstances should a foreign body be allowed to remain in the esophagus beyond 24 hours from presentation.

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