Boerhaave's Syndrome and Esophageal Rupture скачать в хорошем качестве

Boerhaave's Syndrome and Esophageal Rupture

Homepage: EMNote.org ■ 🚩Membership: https://tinyurl.com/joinemnote 🚩ACLS Lecture: https://tinyurl.com/emnoteacls Esophageal Rupture Esophageal Rupture Esophageal rupture is a serious, life-threatening medical condition Iatrogenic perforation is the most common cause Multiple potential origins exist, including trauma and medical complications Boerhaave's Syndrome Full-thickness esophageal wall perforation Typically caused by sudden, forceful vomiting Most commonly occurs in distal left esophagus Develops from rapid increase in intraesophageal pressure Pathophysiology Perforation allows esophageal contents to leak into surrounding spaces Potential complications include: Necrotizing mediastinitis Pneumonitis Peritonitis Systemic shock Clinical Features - Pain Acute, severe, widespread pain Pain localizes in chest, neck, and abdomen Pain radiates to back and shoulders Swallowing intensifies pain sensation Clinical Features - Additional Symptoms Dysphagia (difficulty swallowing) Respiratory distress Hematemesis (blood vomiting) Peripheral cyanosis Physical Examination Abdominal muscular rigidity Hypotension Elevated body temperature Accelerated heart rate Increased respiratory rate Cervical subcutaneous emphysema Mediastinal air (pneumomediastinum) detection - Hamman's crunch Diagnosis Immediate surgical consultation required Initial management focuses on: Aggressive shock management Broad-spectrum intravenous antibiotics Primary imagingContrast CT of neck and chest Additional diagnostic procedures if needed: Flexible endoscopy Esophagography with water-soluble contrast Treatment Surgical intervention mandatory Treatment strategy depends on: Perforation location Perforation size Patient's overall clinical status