Forign bodies

Foreign Bodies:-
▪ Children are found of putting objects into
various orifices either their own or others due
to curiosity or innocence , during the oral
phase.
▪ Objects inserted into the nose, ears, anus,
vagina are usually easy to manage.
▪ But foreign bodies in the mouth can be
difficult and often life – threatening because
they may track down into the respiratory tract
or in the alimentary tract
▪ Foreign bodies in the eyes may also create serious problem.

Types:-

▪ Foreign bodies in Respiratory tract
▪ Foreign bodies in alimentary tract
▪ Foreign bodies in the eyes.

Forign bodies in respiratory tract:-

▪ Aspiration of foreign bodies into the
respiratory tract is quite common in
children.
▪ About 75% cases seeds, nuts, and other
vegetable matters are inhaled in the
airways.
▪ Insert materials like glass bead, plastic
piece( from toy, ball pen) stone, screw,
can also aspirate in respiratory passage.

Clinical features:-
Foreign body in the nose
▪ Nasal obstruction
▪ Sneezing
▪ Discomfort and serosanguinous
discharge.

Forign body impacted in the larynx:-
▪ Sudden choking
▪ Aphonia
▪ Stridor or violent inspiratory efforts or
even death, if impaction is complete.

Foreign bodies in the trachea:-
▪ Spasmodic paroxysmal coughing
▪ Wheezing
▪ Hoarseness
▪ Hemoptysis
▪ Cyanosis
▪ Dyspnea

Foreign bodies in the bronchus:-
▪ Tachypnea
▪ Cough
▪ Wheezing
▪ Pneumonities
▪ Bronchiectasis
Complications of long standing foreign
bodies in the respiratory tract may present with repeated pneumonia, lung abscess, atelectasis and emphysema.

Diagnosis:-
▪ Plain chest X
-ray
▪ Bronchoscopy

Management:-
▪ Emergency management of foreign body
inhalation at home can be done with
precautions by hanging the child upside
down, thumping over the back, groping
with fingers in the pharynx, backblows, chest thursts, Heimlich maneuver etc.
▪ In hospital, once the diagnosis is established or strongly suspected, bronchoscooy should be done as soon as possible.
▪ After bronchoscooy some children may need humidification, parenteralsteroids
antibiotics and chest physiotherapy.
▪ Tracheotomy may be needed when large
vegetable foreign body swells up and
difficult to remove through larynx.
▪ Thoracotomy and bronchotomy may be required in case of impacted long standing foreign bodies in the bronchus.

Forign bodies in
Alimentary tract:-

▪ Ingestion of foreign bodies is also
common like inhalation.
▪ The majority of swallowed foreign bodies
are spontaneously passed in the stool but
some require endoscopic or operative removal.
▪ The commonly ingested foreign bodies are coins, button cell, key, safety pin, rings, pencil sharper, cotton from cloths.

Clinical features:-

If the foreign bodies gets impacted in the
esophagus
▪ Dysphagia
▪ Drooling Of saliva
▪ Retrostetnal or epigastric discomfort.

When the foreign body passed beyond the esophagus:-
▪ Asymptomatic
▪ Spontaneously removed in the stool
within 4-5 days.

Impaction of foreign body in GI tract:-

▪ Intestinal obstruction
▪ Peritonitis.

Diagnosis:-
▪ X-ray neck, chest or abdomen
▪ Esophagoscopy
▪ Barium studies
▪ Ultrasonography

Management:-
▪ When foreign body is impacted in the esophagus, it can be managed simply eating bulk or mashed potatoes or bananas, which may help in forcing a
foreign body down the esophagus into the stomach.
▪ Smooth surface foreign bodies can be extracted by the Foley’s catheter from the esophagus.
▪ No need of use of purgatives when the foreign body passes down the stomach.
▪ Normal diet with roughage should be given with adequate amount of water.
▪ Passage of foreign body in the stool should be checked.

Foreign bodies
in the Eyes:-

▪ Dust, sand, wood, glass particles, metal splintes etc may get enlodged into eye,making injury of the cornea,conjunctiva,
sclera and even the eye ball.

Clinical features:-

▪ Severe pain
▪ Lacrimation
▪ Foreign body sensation
▪ Photophobia
▪ Redness
▪ Itching
▪ Swelling
▪ Infection

Management:-
▪ The condition should be managed as emergency
▪ Instruction to be given to avoid rubbing.
▪ If the foreign body is not embedded, it can be removed by corner of clean cloth or by blinking eyelids under water.
▪ The embedded foreign body should be removed through irrigation Or cotton –tip
applicator or magnet.
▪ Antibiotic therapy should be given to prevent infection.
▪ Aseptic eye care and follow-up are essential.
▪ Surgical removal may be needed in case of intraocular foreign body.

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