CC Nov 2015 Battery ingestion

echoecho's version from 2015-12-13 15:42


Question Answer
Why is disc battery ingestion in children an increasingly significant problem in the US?due to the increasing number of products containing disc batteries (battery-operated toys, watches, calculators, hearing aids)
Reports of about ____ cases annually in the US with death being rare?2,100
Children < ___ y.o. are mostly commonly affected, followed by what age group category?< 6 y.o.; elderly
What gender are more often involved?male
*** What hotline was established in 1982 as a case registry and emergency consultation service? Phone number?1) The National Battery Ingestion Hotline (NBIH) 2) 202-625-3333
Disc batteries range in what sizes? in what weights?7.9 mm to 23 mm; 1-10 grams
In 97% of cases, ingested disc batteries of what size are seen?< 15 mm (most commonly 7.9 and 11.6 mm)
Most disc batteries pass through the GI tract without incident. ___% within 24 hours; ____% within 48 hours, ____% within 72 hours; ____% within 96 hours?23; 61; 78; 86
1% of batteries will take > ____ weeks to pass?2
Problems arise if what happens to the batteries?they become lodged in the GI tract
Batteries > ___ mm diameter may lodge in the esophagus? This is more common in what age group category?20; younger children (because of smaller anatomic structures)j
List complications that arise from retention of battery in the esophagus?1) pressure necrosis of the esophagus 2) chemical burns from battery's electrical current and liquefaction necrosis from alkali leakage
Perforation has developed as soon as ___ hours after ingestion?6
Most disc batteries are alkaline, but newer lithium batteries are now available in what sizes?disc and button
*** Larger lithium batteries lead to what compared to other batteries, why?1) more significant complications 2) due to their size and ability to generate a larger current with burns in 2 - 2.5 hours
There are usually no adult witnesses for most ingestions. While the majority of children who ingest disc batteries are asymptomatic and pass it within 2-7 days, ___% develop symptoms?10
Nickel-plated batteries may cause what?Due to what?1) rashes 2) hypersensitivity
Lodging of a battery in the GI tract is most often associated with what symptom? What other symptoms can occur?1) emesis 2) abdominal pain, fever, abnormally colored stools (green), diarrhea, rash, or respiratory distress
What two things are needed to establish the dx?1) history 2) chest x-ray
What views are necessary (x-ray) to confirm presence of a battery in the esophagus?1) AP (anterior-posterior) 2) lateral
The radiographic appearance of a disc battery is similar to that of a coin in ____ view?face
On cross section, however, there is a step-off where the ______ and ______ connect?1) cathode 2) anode
About ___ - _____ of batteries seen in the esophagus on the initial radiograph will pass into the stomach?1/3
Because of potential complications, batteries remaining in the esophagus require _____ removal, preferably within ____ hours of ingestion?1) endoscopic 2) two
Endoscopic removal from the esophagus is successful in ____% of cases?90
If emergent endoscopy is unavailable, what second-line procedure can be done only by physicians with experience in this procedure?inflated Foley catheter with fluoroscopy
Why should children with batteries in the esophagus not receive ipecac?retching may cause further damage to the esophagus
Why should children with a battery that has passed into the stomach not be given ipecac? because vomiting may cause retrograde movement of the battery into the esophagus
*** Management of the patient who has ingested a DISC battery is dependent on what 4 conditions?1) age of patient 2) size and location of the battery 3) whether there was simultaneous ingestion of a magnet 4) presence of symptoms
The presence of symptoms, even if mild, is an indication of removal, true or false?true
If no symptoms are present, what are the 2 theories as to how to manage the patient?1) most say endoscopic removal of all batteries in the esophagus within 2 hours of ingestion 2) others recommend observation for up to 24 hours
Corrosive or chemical injury of the esophagus has been reported in as little as ___ hours after ingestion?two
What should be done if batteries have passed into the stomach?they do not need to be removed unless they cause symptoms or are present in the stomach AFTER 4 days (child < 6 years of age, battery > 15 mm)
Website that the NBIH has put out for algorithm for the management of battery ingestions?
Once the battery is past the duodenal curve, 85% pass within ____ days?3
Small magnets are another pediatric ingestion concern, disc-shaped rare-earth magnets can be very similar in size and appearance as batteries, is the potential for GI injury greater or lesser for these magnets?greater
What can be the cause of intestinal perforation with magnets?the strong attraction across mucosal surfaces across mucosal surfaces in adjacent segments of intestine
What is the treatment for magnet ingestion?urgent surgical removal
A single magnet may pass without injury if what is not present?metallic objects
*** SUMMARY = Children < _____ years of age are most commonly affected in way of battery ingestion. Which group comes next?1) 6 2) elderly
*** SUMMARY = what gender are most involved in battery ingestion?male
*** SUMMARY = List the 3 complications that may arise from retention of the battery in the esophagus?1) pressure necrosis of the esophagus 2) chemical burns from the battery's electrical current 3) liquefaction necrosis from alkali leakage
*** SUMMARY = What 2 things are needed to establish the dx?1) history 2) chest x-ray
*** SUMMARY = What 2 views are needed in way of chest x-ray for diagnosis?1) AP (anterior-posterior) 2) lateral
*** SUMMARY = Management of a patient who has ingested a DISC battery is dependent on what 4 conditions?1) patient's age 2) size and location of the battery 3I) whether there is simultaneous ingestion of a magnet 4) presence of symptoms