Q: Which one is more prone to cause immediate esophageal injury and esophageal perforation? (select one)
A) Acid-induced injury
B) Alkali-induced injury
Answer: B
Contrary to the popular belief alkali based solutions are more prone to cause penetrating injury. Extensive transmural damage can happen within seconds resulting in esophageal perforation and deadly mediastinitis. It is called liquefactive necrosis. If a patient survives the immediate ordeal, it follows by vascular thrombosis, extensive sloughing, and ulceration, development of granulation tissue and fibrosis. re-epithelialization occurs with stricture formation.
Acid-based solutions are less prone to cause esophageal damage as they cause unbearable pain upon contact with the oropharynx, and stimulated gagging.
#toxicology
References:
1. Zargar SA, Kochhar R, Nagi B, et al. Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history. Am J Gastroenterol 1992; 87:337.
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