FOREIGN BODY INGESTION (ESOPHAGUS) 3 constrictions of the esophagus a. cricopharyngeal area b.

. crosses the aorta and left main bronchus c. pierces the diaphragm children account for 70 percent of foreign body ingestion Symptoms: dysphagia and odynophagia Position of a foreign body can be accurately localized by the patient - if the foreign body is lodged in the cervical esophagus pressure against the back of the larynx and trachea may produce hoarseness, cough and dyspnea PA and lateral x-rays are needed for visualization of the foreign body 3 stages of foreign body ingestion: a. First stage: violent paroxysm of coughing or gagging (when the foreign body is first swallowed) - resisting the urge to do something b. Second stage: symptom less interval (foreign body has lodged and symptoms are no longer produced) c. Third stage: symptoms produced by complications. (discomfort, dysphagia, obstruction, or perforation of the esophagus). Esophageal foreign bodies require more urgent treatment than those in the tracheobronchial tree due to PERFORATION and resultant mediastinitis Coins and other disc shaped objects generally occur in a transverse direction in the esophagus and antero-posteriorly in the trachea. Generally trapped at the level of the CRICOPHARYNGEUS MUSCLE in children. IN GENERAL: foreign bodies that have reached the stomach will pass through the remainder of the gastrointestinal tract without difficulty. FOR EXCEPTION: objects over 5 cm in length such as bobby pins, ingested by children age two or under. At that age, straight objects cannot traverse the duodenal bends and perforate. Foreign body that has passed the stomach should be instructed to continue normal diet. ESOPHAGUS 1. Difficulty in swallowing (dysphagia) solids or liquids. 2. complete obstruction (inability to swallow) 3. Odynophagia 4. Regurgitation of undigested food 5. Hematemesis 6. Sensation of foreign body 7. Lump in throat 8. heartburn 9. weight loss 10. hoarseness TRACHEA 1. Cough (productive and non-productive) 2. Hemoptysis 3. Wheeze 4. Hoarseness 5. Atelectasis or emphysema 6. Recurrent or persistent pneumonitis or lung abscess 7. Aspiration of foreign material or object 8. unexplained radiographic shadows 9. retention of secretions in the

11. sensitivity to hot or cold foods

tracheobronchial tree 10. dyspnea not secondary to cardiopulmonary or metabolic decompensation.

FOREIGN BODY ASPIRATION Foreign body lodged in the larynx or cervical esophagus: discomfort, hoarseness, cough and dyspnea Foreign bodies in the trachea may move back and forth between the carina and the bottom of the glottis with respiration, producing an audible slap and thud Foreign body in the bronchus: - complete obstruction: peripheral atelectasis results as air is absorbed from the distal lung into the blood. - Non-obstructive: allowing air to flow around on both inspiration and expiration which may result in an asthma-like localized wheezing. - Partial obstruction (check valve): brnchus expands on inspiration, allowing air to flow past it into the distal lung. Bronchus contracts around the foreign body during expiration trapping air in the distal lung, which produces an emphysema peripheral to the foreign body. -