Q) 26. Non specific retrosternal pain associated with abnormal belching is due to
A. UES closure
C. Mediastinal nerve plexus irritation
D. Impacted foreign body
Q 27) Esophageal perforation true is
a) Contrast esophagogram in upright position is better
b) Massive hematemesis
c) Mid esophageal perforation causes right pneumothorax
d) More than 80% crepitus seen
Chest pain that is precipitated by meals, occurring at night while supine, nonradiating, responsive to antacid medication, or accompanied by other symptoms suggesting esophageal disease, such as dysphagia or regurgitation, should trigger the thought of possible esophageal origin
In suspected esophagus perforation first use water-soluble agents. If they are extravasated into the mediastinum, they are rapidly absorbed and do not incite an inflammatory response.
Whenever an initial study with water-soluble contrast material is negative, however, it should be immediately
followed by a barium esophagogram, which because of its higher density has been reported to
increase the sensitivity for detecting esophageal leaks by 15% to 25%.
Ref Shackelford page 94
Four most common presenting symptoms to be pain (71%), fever (51%), dyspnea (24%), and crepitus (22%)
Shack page 479
In stable patient, a contrast esophagogram is often the modality of choice as it is useful for diagnosis and therapeutic
planning. In contrast, more urgent presentations CT scan and endoscopy
A contrast esophagogram should be obtained in theright lateral decubitus position as the upright study may
lead to rapid passage of the contrast, resulting in a false negative study. In the decubitus position, the contrast
agent fills the entire esophagus illustrating even the subtle site of perforation and its interconnecting cavities.