Acute Esophageal Necrosis
Description
◉ Case 1 –
• Elderly Male with Multiple Comorbidities
• •Age/Sex: man, 79 years old
• Presentation: hypotension (78/58), repeated coffee-ground vomiting, and hemoglobin decrease (12.1 → 8.7 g/dL)
• Past medical history: GERD, HTN, bladder cancer, ESRD (on peritoneal dialysis), COPD, and CHF.
• Lab results include thrombocytopenia (80k), creatinine 3.4 mg/dL, hypoalbuminemia (1.2 g/dL), and INR 2.7.
• Endoscopy: duodenopathy; black esophagus (distal third, preserving GEJ)
◉ Case 2:
• An Alcohol Use Disorder in a Middle-Aged Male
• Male/Female: 54 years old Male African American
• Presentation: Unresponsive during hematemesis; tachypnea, hypotension (SBP ~50s), and cardiac arrest with ROSC; octreotide, PPI, and transfusion were administered.
• Past medical history: hepatic steatosis, alcoholism, and recurrent pancreatitis
• Lab results: Cr 3.5, K⁺ 8.2, lactate 23, BUN 61, INR 1.5, and Hb 15.1 g/dL (after transfusions).
• Endoscopy: widespread duodenal ulcers; black esophagus (GEJ → mid esophagus)
• Imaging: A 6.4 cm pseudocyst (CTA) and severe acute pancreatitis,
A rare and potentially fatal source of upper gastrointestinal bleeding that ends abruptly at the GEJ and is characterized
by circumferential black esophageal mucosa on endoscopy.
• The study of epidemiology:
more well-known as a result of the increased use of endoscopy for gastrointestinal bleeding.
Most afflicted are older persons, with a male preponderance (~4:1).
◉ Pathophysiology:
• The "two-hit" multifactorial model
• Ischemic damage, including sepsis, CHF, hypoperfusion/shock, and renal failure
• Chemical harm (duodenal ulcers, severe acid reflux, and alcohol-induced mucosal damage)
• weakened defenses (cancer, hypoalbuminemia, chronic disease, malnutrition)
• The combination of hemodynamic shock, GI mucosal damage, and significant comorbidities in each of the examples you mentioned is a recipe for AEN.
◉ Clinical Characteristics:
• The most frequent type of GI bleeding is hematemesis, melena, or coffee-ground emesis.
may exhibit altered sensorium and shock.
◉ Making a diagnosis:
• (Black circumferential mucosa halting at GEJ) Endoscopy is diagnostic.
A biopsy can rule out infections or caustic intake, but it is not necessary.
Protocol
Management
• Stabilization: blood transfusions, fluids, and vasopressors if necessary.
• NPO for esophageal rest.
• IV PPIs at high doses to reduce stomach acid.
• Shock, infection, metabolic disorders, pancreatitis, and renal failure are the appropriate underlying triggers.
• Antibiotics are not usually necessary unless there is proof of an infection or perforation.
• Steer clear of NG tubes (perforation risk).
• Pain Management in Critically Ill Patients Problem Faced:
• Moderate to severe pain is common in critically ill patients, particularly after invasive procedures or extended intensive • care unit stays. Because of drowsiness or communication difficulties, pain may go unnoticed.
• How Managed:
• Use pain scales appropriate for both conscious and unconscious individuals to conduct routine, standardized pain assessments.
• Create and implement a multidisciplinary pain management plan that guarantees prompt, patient-specific administration of analgesics (such as fentanyl or paracetamol).
• Improve nursing staff's ability to recognize pain, particularly in non-verbal patients, by educating and training them on a regular basis.
• Nursing Interventions:
• Keep an eye on vital signs and look for nonverbal cues that someone is in discomfort.
• Administer prescription painkillers and periodically assess their efficacy.
• Record pain levels both before and after the intervention.
• Pain During Labor and Delivery Problem Faced: Women in labor experience significant pain, anxiety, and risk for slower
labor progression if pain is not managed effectively.
• How Managed:
• Offer ongoing monitoring, emotional support, and information on the progression of labor.
• As directed, provide both pharmaceutical and non-pharmacological pain management approaches, such as breathing exercises and posture.
• Nursing Interventions:
• Lead ladies in breathing and relaxation techniques.
• Use comfort techniques like massage, warm compresses, or shifting positions.
• Throughout, keep an eye on the mother's and fetus' health.
• Rapidly developing neurological impairments, aspiration risk, hemodynamic instability, and airway compromise are the
• challenges associated with acute stroke management.
How Managed:
• prompt neurological evaluation and stroke protocol activation (CT scan, thrombolysis/tPA if necessary)
• Multidisciplinary interventions to stabilize airway and blood pressure.
• Nursing Interventions:
• Conduct frequent neurological checks and Glasgow Coma Scale assessments.
• Ensure airway patency; position patient to prevent aspiration.
• Monitor for signs of increased intracranial pressure and report changes.
• Educate family on stroke signs, rehabilitation, and prevention.
Notes
For more detsails visit: https://pmc.ncbi.nlm.nih.gov/articles/PMC5973485/?utm_source=chatgpt.com
