Gastrointestinal perforation Flashcards
Give 3 major complications of GI perforation:
1) septic shock
2) multi-organ failure
3) death
Give 4 causes of upper GI perforation:
1) peptic ulcer perforation
2) gastric cancer or oesophageal cancer
3) ingestion of foreign body e.g. battery acid, caustic soda
4) excessive vomiting
Give 6 causes of lower GI perforation:
1) diverticulitis
2) colorectal cancer
3) appendicitis
4) foreign body insertion
5) severe colitis e.g. Crohn’s disease
6) toxic megacolon
Give 3 causes of perforation that can affect any region of the GI tract:
1) gastroscopy/ colonoscopy
2) trauma
3) mesenteric ischaemia
What is the presenting complaint associated with GI perforation?
acute, severe abdominal pain with peritonitis
Give 3 associated symptoms of GI perforation:
1) malaise
2) vomiting
3) lethargy
What palpation findings is classic of GI perforation?
guarding (peritonitis)
What does widespread peritonism indicate?
diffuse contamination of the abdomen (and likely that surgery will be required over conservative management)
What presenting complaint would suggest a thoracic perforation such as oesophageal rupture?
acute onset pain radiating to the back which is typically worse on inspiration
Give 6 blood tests that should be urgently requested for any presentation of acute abdomen:
1) FBC
2) U&Es
3) LFTs
4) CRP
5) clotting screen
6) group and save
What is the gold standard imaging technique for any GI perforation?
Contrast-enhanced CT scan
What CXR sign indicates GI perforation?
free air under the diaphragm
What AXR sign indicates GI perforation?
Rigler’s sign
What is Rigler’s sign?
where the bowel can be visualised on both sides due to intra- and extra- luminal air
What are the 4 pre-operative steps of management for a GI perforation?
1) broad spectrum antibiotics
2) nil by mouth and NG tube
3) fluid resuscitation
4) analgesia
