Dysphagia Six Weeks Following Accidental Corrosive Ingestion
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
The clinical features depend upon the phase and severity of injury. In the acute phase, patients present with odynophagia, drooling of saliva due to dysphagia, ulceration of the lips, tongue, and oral cavity mucosa. Airway involvement can result in stridor requiring emergency tracheostomy. Intent of ingestion of corrosive substances also determines the clinical presentation. In suicidal ingestion, patients have an idea of what they are taking that often produces initial hesitancy resulting in extensive damage to the upper aerodigestive tract. Accidental ingestion is associated with intake of a relatively large quantity of corrosive substance as the patients are unaware of what they are taking resulting in esophageal and gastric injury. Vomiting, common with gastric injury, aggravates esophageal damage due to regurgitated corrosives. Hematemesis, although rare, is a manifestation of gastric injury. Chest pain, pleural effusion, and mediastinitis suggest esophageal perforation while peritonitis indicates transmural gastric injury with perforation.
Fructose-1,6-diphosphatase deficiency
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop in Atlas of Inherited Metabolic Diseases, 2020
There may be convulsions or other manifestations of hypoglycemia. There may be flushing [2], or pallor and sweating. Vomiting may be complicated by hematemesis [14, 15]. Hypotonia and muscle weakness have been observed. The electroencephalograph (EEG) may be abnormal during the acute attack and normal later. Fast spindle-shaped bursts on a slow amplitude pattern have been described [2], as well as a slow-wave pattern [16]. Intellectual development is usually normal (Figures 49.2 and 49.3). Of course, impaired mental development, as well as death may accompany neonatal or early infantile hypoglycemic crises, but fasting tolerance improves with age, and patients normal by childhood usually develop normally. In addition to the lactic acidemia, analysis of the blood reveals increased concentrations of alanine and uric acid [17]. In some attacks, there may be acidosis without hypoglycemia. Glycerol and glycerol-3-phosphate have been found in the urine [18, 19].
Gastrointestinal diseases and pregnancy
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Typical symptoms of PUD include epigastric pain, which is relieved by food or antacids. Patients often describe a dull “gnawing” or burning sensation, which may awaken them at night or may occur in the morning before eating or after meals. Because the abdominal pain is often relieved by eating, patients with PUD may gain weight. Other symptoms arise when duodenal or gastric ulcer is complicated by hemorrhage, perforation, penetration, or obstruction (Table 3). If the ulcer bleeds, the patient may develop black or tarry stools (melena) or hematemesis. Ulcer penetration into an arterial blood vessel can lead to massive, brisk bleeding with rapid transit of blood through the gastrointestinal tract and bright red blood per rectum (hematochezia). Abdominal pain that radiates to the back indicates possible penetration of the ulcer posteriorly through the wall of the stomach or duodenal bulb into surrounding organs. Duodenal bulb ulcers may penetrate into the pancreas, whereas gastric ulcers can erode into the liver or colon. The sudden onset of severe pain in conjunction with physical findings of an acute abdomen (rebound tenderness, guarding, absent bowel sounds, and distention) is associated with free perforation of the ulcer, which is a surgical emergency. Finally, prolonged nausea and vomiting can result from gastric outlet obstruction caused by edema and inflammation surrounding an ulcer crater located in the prepyloric or pyloric region. It is important to note that complicated ulcer disease may present with no antecedent history of abdominal pain or other symptoms.
Predictive factors of therapeutic intervention in on-call endoscopy for suspected gastrointestinal bleeding
Published in Scandinavian Journal of Gastroenterology, 2018
Chan Hyung Lee, Hyuk Yoon, Yoon Jin Choi, Eun Sun Jang, Jaihwan Kim, Cheol Min Shin, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hayng Jeong, Nayoung Kim, Dong Ho Lee, Joo Sung Kim
The baseline characteristics of the patients with and those without therapeutic intervention are compared in Table 1. No significant differences were found between the two groups in the variables of age (p = .237) and sex (p = .279). The patients who had symptoms of hematemesis were more likely to have a therapeutic intervention during the on-call endoscopy (p < .001). However, melena was shown as a negative predictive factor in therapeutic intervention (p = .002). The prevalence of liver cirrhosis was significantly higher in the patients with therapeutic intervention (37.9% vs 20.5%, p = .002), whereas the prevalence of hypertension was lower (23.5% vs 35.9%, p = .026). Any laboratory parameters and medications could not be shown as having a predictive value for therapeutic intervention.
Timing of embolic phenomena after hydrogen peroxide exposure – a systematic review
Published in Clinical Toxicology, 2023
Andrew King, Megan Fee, Erin McGlynn, Brandon Marshall, Katherine G. Akers, Benjamin Hatten
Twenty-seven of 49 patients with portal venous gas (55%) as the primary finding had gastrointestinal bleeding. Of those 27 patients, 19 (70%) presented with hematemesis, while 8 (30%) did not. Severity of the gastrointestinal bleeding is not described. However, all patients with isolated portal venous gas and gastrointestinal bleeding had a full recovery regardless of hyperbaric oxygen therapy. Nearly all patients (47 of 49) with portal venous gas presented with nausea, vomiting, or abdominal pain, while one patient presented with chest pain and one with a sore throat. Six cases with primary portal venous gas were low-concentration ingestions. Of those, four patients developed gastrointestinal hemorrhage, and two did not. Thus, most patients with portal venous gas experienced early gastrointestinal symptoms and more than half experienced gastrointestinal bleeding regardless of concentration. Symptoms typically resolved with supportive care.
Erythrodermic psoriasis secondary to systemic corticosteroids
Published in Baylor University Medical Center Proceedings, 2020
Matthew Heinrich, Elizabeth Cook, Jenna Roach, Rita Medrano Juarez, Drew Payne, Randy Atkins, Cloyce Stetson
A 58-year-old woman presented with a 2-month history of rash initially involving her left lower extremity, which became more diffuse. At an outside clinic, the patient told the provider that she had a history of psoriasis, and oral prednisone was prescribed and continued for 5 months. During this time, the dosage was up-titrated but symptoms persisted. The prednisone was stopped due to hematemesis and concern for gastritis. Over the following 2 weeks, the rash involved >90% of her total BSA. The rash was erythematous and exfoliative with significant sloughing of skin, accompanied by pruritus, burning pain, occasional clear discharge, and xerophthalmia. Notably, there was no mucosal membrane involvement. A punch biopsy was obtained, revealing erythrodermic psoriasis (EP). The patient was treated with intravenous fluids, moisturizing eye drops, triamcinolone 0.1% ointment for the body, and hydrocortisone 2.5% ointment for the face, resulting in significant improvement of the rash.
Related Knowledge Centers
- Endoscopy
- Gastrointestinal Tract
- Mouth
- Vomiting
- Blood
- Hemoptysis
- Nosebleed
- Suspensory Muscle of Duodenum
- Nose
- Throat