Esophageal perforation: Difference between revisions
No edit summary |
No edit summary |
||
| Line 15: | Line 15: | ||
*Zollinger-Ellison syndrome | *Zollinger-Ellison syndrome | ||
== | ==Clinical Features== | ||
===History=== | ===History=== | ||
*Pain | *Pain | ||
| Line 28: | Line 28: | ||
**Takes time to develop | **Takes time to develop | ||
**Absence does not rule out perforation | **Absence does not rule out perforation | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 37: | Line 33: | ||
{{Thoracic trauma DDX}} | {{Thoracic trauma DDX}} | ||
==Diagnosis== | |||
===Imaging=== | |||
*[[CXR]] | |||
*CT chest | |||
*Emergent endoscopy | |||
==Management== | ==Management== | ||
*Volume resuscitation | *[[Volume resuscitation]] | ||
*Broad-spectrum IV | *Broad-spectrum IV [[antibiotics]] | ||
*Emergent surgical consultation | *Emergent surgical consultation | ||
| Line 46: | Line 48: | ||
*[[Esophageal Injury]] | *[[Esophageal Injury]] | ||
== | ==References== | ||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 23:36, 13 May 2015
Background
Causes
- Iatrogenic
- Boerhaave syndrome
- Thoracic Trauma
- Penetrating
- Blunt (rare)
- Caustic ingestion
- Foreign body
- Bone, button battery
- Infection (rare)
- Tumor
- Aortic pathology
- Barrett esophagus
- Zollinger-Ellison syndrome
Clinical Features
History
- Pain
- Acute, severe, unrelenting, diffuse
- May be localized to chest, neck, abdomen; radiate to back and shoulders
- Dysphagia
- Dyspnea
- Hematemesis
Physical Exam
- Cervical subcutaenous emphysema
- Mediastinal emphysema
- Takes time to develop
- Absence does not rule out perforation
Differential Diagnosis
Chest pain
Critical
- Acute coronary syndromes (ACS)
- Aortic dissection
- Cardiac tamponade
- Coronary artery dissection
- Esophageal perforation (Boerhhaave's syndrome)
- Pulmonary embolism
- Tension pneumothorax
Emergent
- Cholecystitis
- Cocaine-associated chest pain
- Mediastinitis
- Myocardial rupture
- Myocarditis
- Pancreatitis
- Pericarditis
- Pneumothorax
Nonemergent
- Aortic stenosis
- Arthritis
- Asthma exacerbation
- Biliary colic
- Costochondritis
- Esophageal spasm
- Gastroesophageal reflux disease
- Herpes zoster / Postherpetic Neuralgia
- Hypertrophic cardiomyopathy
- Hyperventilation
- Mitral valve prolapse
- Panic attack
- Peptic ulcer disease
- Pleuritis
- Pneumomediastinum
- Pneumonia
- Rib fracture
- Stable angina
- Thoracic outlet syndrome
- Valvular heart disease
- Muscle sprain
- Psychologic / Somatic Chest Pain
- Spinal Root Compression
- Tumor
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Diagnosis
Imaging
- CXR
- CT chest
- Emergent endoscopy
Management
- Volume resuscitation
- Broad-spectrum IV antibiotics
- Emergent surgical consultation