78 y/o female complaints of severe right upper quadrant pain that radiated to the epigastric region and back associated with nausea and nonbilious vomiting. PMH: chronic pancreatitis, congestive heart failure, and poorly controlled type 2 diabetes. She underwent a remote cholecystectomy. Temp: 39.3°C, BP: 159/73 mm Hg, She appeared to be in severe distress. The epigastric and right upper quadrant regions were very tender to palpation. -Elevated serum glucose (369 mg/dL), low serum sodium (131 mmol/L), chloride (94 mmol/L), and bicarbonate (19 mmol/L). -Urine sample showed ketones, while serum BHB was elevated (1.64 mmol/L). -CT of the abdomen revealed duodenal thickening. Diagnosis of diabetic ketoacidosis was made and started appropriate treatment. She continued to vomit despite the use of anti-emetics, bowel rest, and diabetic ketoacidosis treatment. Upper endoscopy showed a distally black esophagus. What is it? How to proceed with treatment?

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Ac.Necrotising Esophagatis.. Acute necrotizing esophagitis is thought to arise from a combination of an ischemic insult to the esophagus, an impaired mucosal barrier system, and a backflow injury from chemical contents of gastric secretions. The tissue hypoperfusion derives from vasculopathy, hypotension, or malnutrition.

Acute necrotising oesophagitis Caused by combination of uncontrolled DM, vascular injury due to vasculopathy, and acid injury. Treatment is tight control of DM with insulin, control of gastric acidity by IV PPI and rest for stomach . Complications may be oesophageal perforation and stricture .

Thank you, Doctor
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Acute necrotising oesophagitis due ischaemia of the oesophagus and vasculopathy and irritation of the mucosa by regurgitation of acid from stomach content rich in acid. Strict diabetic control To reduce acidity by PPI Rest to stomach Watch for electrolytes imbalance

Acute Necrotizing oesophagitis

Thanks Dr Pushkar Bhomia
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Necrotising infection of Esophagus. Need to start broad spectrum antibiotics. Might require vascular evaluation.

Acute Necrotizing Esophagitis Rx strict aggressive control of DM Aggressive control Ischemia of Esophagus Strong PPI n Antacid Gel

Acute necrotising edophagitis.treat the underlying cause, maintain fluid/electrolyte balance, keep patient NBM,and PPI's are part of the treatment.

Acute nectotising oesophagitis

Ac. Necrotizing Esophagitis

Is it Thromboemolic phenomenon causing oesophageal mucosal changes. Comments requested.

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