Physical Exam Key Points

1. ABCs. Assess airway, breathing, and circulation first.

2. General appearance and vital signs. Often normal if the foreign body has passed beyond the proximal esophagus.

3. Oropharynx. May reveal excoriations or bloody streaks resulting from the ingested foreign body.

4. Neck. Swelling, redness, or crepitus of the neck may be present if there is esophageal perforation.

5. Lungs. If the foreign body is compressing the trachea, stridor or wheezing may be present. Asymmetric breath sounds may be auscultated.

6. Abdomen. Evaluate for tenderness and signs of peritonitis.

B. Laboratory Data. Not useful when considering a foreign body in the GI tract.

C. Radiographic and Other Studies. The most important goal in treatment of any foreign body in the GI tract is locating the object. 1. Plain chest x-ray. Obtain AP and lateral views; include the upper airway and upper stomach. These views usually indicate the location of the foreign body. Note that esophageal foreign bodies usually become lodged in one of three places in the esophagus: the thoracic inlet (60-80%), the level of the aortic arch (5-20%), and the gastroesophageal junction (10-20%). Coins are usually seen on edge on lateral films. Coins in the esophagus are seen in the coronal orientation, and coins in the

airway appear in the sagittal orientation. X-ray films will also determine the number of foreign bodies ingested.

2. Abdominal x-ray. Foreign bodies that have traversed the esophagus and are present in the stomach or intestines will be visualized on these views.

3. Thin barium esophagogram. Perform when a radiolucent foreign body is suspected (eg, plastic toys, glass, aluminum, pieces of wood).

4. Hand-held metal detectors. May be used as adjunctive tests in an initial screening to locate the foreign body. These devices should be operated by persons experienced in their use.

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