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    Foreign Bodies of Air Passages and Food Passage

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    Ramli Hassan
    This document summarizes information about foreign bodies in the air passages and food passage. It discusses where different sized foreign bodies may lodge in the airways, common objects that are aspirated, clinical features of foreign bodies at different locations, and methods for diagnosis and removal. For food passage, it covers common sites of lodgement, risk factors, signs and symptoms, investigations like x-rays, and management including endoscopic removal or surgery if needed. Complications are also outlined.

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    Foreign Bodies of Air Passages and Food Passage

    Uploaded by

    Ramli Hassan
    530 views20 pages
    This document summarizes information about foreign bodies in the air passages and food passage. It discusses where different sized foreign bodies may lodge in the airways, common objects that are aspirated, clinical features of foreign bodies at different locations, and methods for diagnosis and removal. For food passage, it covers common sites of lodgement, risk factors, signs and symptoms, investigations like x-rays, and management including endoscopic removal or surgery if needed. Complications are also outlined.

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    This document summarizes information about foreign bodies in the air passages and food passage. It discusses where different sized foreign bodies may lodge in the airways, common objects that are aspirated, clinical features of foreign bodies at different locations, and methods for diagnosis and removal. For food passage, it covers common sites of lodgement, risk factors, signs and symptoms, investigations like x-rays, and management including endoscopic removal or surgery if needed. Complications are also outlined.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    530 views20 pages

    Foreign Bodies of Air Passages and Food Passage

    Uploaded by

    Ramli Hassan
    This document summarizes information about foreign bodies in the air passages and food passage. It discusses where different sized foreign bodies may lodge in the airways, common objects that are aspirated, clinical features of foreign bodies at different locations, and methods for diagnosis and removal. For food passage, it covers common sites of lodgement, risk factors, signs and symptoms, investigations like x-rays, and management including endoscopic removal or surgery if needed. Complications are also outlined.

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    The passage discusses foreign bodies that can lodge in the air passages and food passage, including common objects, sites of lodgement, clinical features and management approaches.

    Common vegetable foreign bodies include peanuts, seeds, and pieces of fruits and vegetables. Non-vegetable objects include plastic toys, safety pins, coins and buttons.

    Symptomology is divided into three stages - an initial period of choking/coughing, a symptomless interval as the mucosa adapts, and later symptoms caused by obstruction, inflammation or trauma from the foreign body depending on the lodgement site.

    Foreign Bodies of Air Passages and Food Passage

    PREPARED BY : NURUL SYAZWANI RAMLI

    Foreign Bodies of Air Passages


    A foreign body (FB) aspirated into air passage can

    lodge in the larynx, trachea, or bronchi (depend on size and nature of FB). Large FB = cant pass thru glottis lodge in supraglottic area. Smaller FB = pass down thru larynx into trachea or bronchi.

    Aetiology
    Vegetable Nonvegetable Peanut (most common) Plastic whistle Almond seed Plastic toys Peas Safety pins Beans Nails / Screws Wheat seed Coins Water melon seed Bones Piece of carrot or apple, etc Buttons Hair clips Marble, etc

    Nature of Foreign Body


    Non-irritating type Eg: plastic, glass, metallic FB symptomless for a long time Irritating type Eg: vegetable (peanuts, beans, seeds, etc) Set up diffuse violent reaction congestion and oedema of tracheobronchial mucosa (vegetal bronchitis) swell up with time causing airway obstruction and later suppuration in the lung.

    Clinical Features
    Symptomatology of FB is divided into 3 stages: 1) Initial period of choking, gagging and wheezing

    Last for a short time FB may be coughed out or it may lodged in the larynx or further down in tracheobronchial tree

    2)

    Symptomless interval
    Resp. mucosa adapts initial symptoms dissappear

    3)

    Later symptoms
    Caused by obstruction to the airway, inflammation or trauma induced by FB and would depend on site of its lodgement.

    Cont. Clinical Features


    Sites of its lodgement: a) Laryngeal FB

    Large FB totally obstruct airway sudden death (unless resuscitative measures urgently). Partial obstructive discomfort, pain in throat, hoarseness of voice, croupy cough, aphonia, dyspnoea, wheezing and haemoptysis.

    b)

    Tracheal FB
    Sharp FB cough, haemoptysis Loose FB move up and down the trachea btwn carina and undersurface of vocal cords audible slap, palpatory thud and asthmatoid wheeze.

    c)

    Bronchial FB
    Right Bronchus (most) becoz wider and more in line with tracheal lumen Totally obstruct lobar or segmental bronchus atelectasis Produce check valve obstruction obstructive emphysema Emphysematous bulla rupture spontaneous pneumothorax Retained FB in lung pneumonitis, bronchiectasis or lung abscess.

    Diagnosis
    Detailed Hx (FB ingestion)

    PE of neck and chest Classical triad


    Sudden onset of coughing Wheezing Diminished air entry

    Radiology: Plain X-Ray CXR at end of inspiration and expiration Fluoroscopy/videofluoroscopy CT chest

    Management
    Laryngeal FB First aid measures:
    1) 2) 3)

    Pounding on the back Turning the patient upside down Heimlichs manoeuvre

    shud not be done if pt. partially obstructed

    4) 5)

    Cricothyrotomy or emergency tracheostomy (if Heimlichs manoeuvre fails) Once emergency over, FB can be removed by direct laryngoscopy or laryngofissure (if found impacted)

    Cont. Management
    Tracheal and Bronchial FBs Can be removed by bronchoscopy with full preparation and under GA Emergency removal not indicated unless theres airway obstruction or vegetable nature and likely to swell up. Methods to remove tracheobronchial FB:
    1) 2) 3) 4)

    5)
    6) 7)

    Conventional rigid bronchoscopy Rigid bronchoscopy with telescopic aid Bronchoscopy with C-arm fluoroscopy Use of Dormia basket or Fogartys balloon for rounded objects Tracheostomy 1st and then bronchoscopy thru the tracheostome Thoracotomy and bronchotomy for peripheral FBs Flexible fibre optic bronchoscopy in selected adult pt.

    Foreign Bodies of Food Passage


    An ingested FB may lodge in: The tonsil The base of tongue/vallecula The pyriform fossa The oesophagus

    Aetiology
    Age (children) Loss of protective mechanism Use upper denture (prevents tactile sensation) Loss of consciousness Epileptic seizures Deep sleep Alcoholic intoxication Carelessness Poorly prepared food Improper mastication Hasty eating and drinking Narrowed oesophageal lumen (oesophageal stricture or ca.) Psychotics (attempt to commit suicide)

    Site of Lodgement of FB
    Just below the cricopharyngeal sphincter

    (commonest site) FB which pass the sphincter can be held up at next narrowing at broncho-aortic constriction or at the cardiac end. Sharp or pointed objects lodge anywhere in the oesophagus.

    Clinical Features
    Symptoms H/O initial choking or gagging Discomfort or pain ( increase on attempts to swallow) Dysphagia Drooling of saliva Respiratory distress Substernal or epigastric pain

    Cont. Clinical Features


    Signs Tenderness (lower part of neck) Pooling of secretions in pyriform fossa on indirect laryngoscopy and not disappear on swallowing FB may be seen protruding from oesophageal opening in postcricoid region.

    Investigation
    Plain X-rays

    Fluoroscopy

    Management
    Oesophagoscopic removal (under GA) Cervical oesophagotomy Transthoracic oesophagotomy

    FB which has reached stomach may pass thru GIT w/o difficulty; stool shud be carefully examined every day. Operative interference may be required when:

    Pain and tenderness in abdomen FB not showing any progress on serial X-rays FB is 5cm or longer in a child belor 2 years Presence of pyloric stenosis

    Complication of Oesophageal FB
    Respiratory obstruction

    Perioesophageal cellulitis and abscess in neck


    Perforation Tracheo-oesophageal fistula (rare)

    Ulceration and stricture.

    Thank You

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