Paeds Vivas · gastroenterology-hepatology-and-nutrition
Oesophagitis, caustic ingestion and oesophageal injury — branching viva
Branching viva across paediatric oesophageal injury: the definition and classification, the oesophageal button-battery emergency, the caustic ingestion pathway, and the child with dysphagia and eosinophilic oesophagitis.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in a mixed emergency department. The consultant asks you to talk through four children: an 18-month-old with a suspected oesophageal button battery, a 2-year-old who has swallowed drain cleaner, a 9-year-old who arrives with a food bolus stuck in the oesophagus, and a teenager who took a doxycycline tablet at bedtime and now has retrosternal pain.
Station opening
Examiner: "Classify oesophageal injury in a child and tell me which one you never let out of your sight." [1]
Strong candidate (must-hit)
- Separates oesophageal injury into the chronic oesophagitides (reflux, eosinophilic, infective and pill oesophagitis) and acute injury (caustic ingestion, button battery and mechanical foreign body); frames the distinction by timescale — oesophagitis over weeks, caustic over hours, a battery over two hours; and names the oesophageal button battery as the one that must be removed within two hours because it burns liquefactively at its negative pole and can form a fatal fistula. [1] [7]
Weak candidate
- "Oesophagitis is just reflux, and if a child swallows something we watch and wait for it to pass." [1]
References6ShowHide
- [1]Mubarak A; Benninga MA; Broekaert I; Dolinsek J; Homan M; Mas E; Miele E; Pienar C; et al Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper. J Pediatr Gastroenterol Nutr, 2021.PMID 33555169
- [2]Anfang RR; Jatana KR; Linn RL; Rhoades K; Fry J; Jacobs IN pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope, 2019.PMID 29889306
- [7]Contini S; Scarpignato C Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol, 2013.PMID 23840136
- [8]Hoffman RS; Burns MM; Gosselin S Ingestion of Caustic Substances. N Engl J Med, 2020.PMID 32348645
- [9]Zargar SA; Kochhar R; Mehta S; Mehta SK The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc, 1991.PMID 2032601
- [11]Lucendo AJ; Molina-Infante J; Arias Á; von Arnim U; Bredenoord AJ; Bussmann C; Amil Dias J; Bove M; et al Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J, 2017.PMID 28507746