gastrointestinal perforation Flashcards
define gastrointestinal perforation?
perforation of the wall of the GI tract with spillage of bowel contents
what are the causes of large bowel perforation?
- Diverticulitis
- Colorectal cancer
- Appendicitis
what are the causes of gastroduodenal perforation?
• Perforated duodenal or gastric ulcer
what are the causes of small bowel perforation?
o Trauma
o Infection (e.g. TB)
o Crohn’s disease
what are the causes of oesophagus perforation?
• Boerhaave’s perforation - rupture of the oesophagus following forceful vomiting
what are the presenting symptoms of large bowel perforation?
o Peritonitic abdominal pain
what are the presenting symptoms of gastroduodenal perforation?
o Sudden-onset severe epigastric pain
o Pain becomes generalised
what are the presenting symptoms of oesophageal perforation?
o Severe pain following an episode of violent vomiting
o May be haemoptysis
o Neck/chest pain and dysphagia develop soon afterwards
signs of GI perforation?
- Very UNWELL
- Signs of shock
- Pyrexia
- Pallor
- Dehydration
- Signs of peritonitis
- Loss of liver dullness
identify investigations for GI perforation?
Bloods
Erect CXR
AXR
gastrograffin swallow
what will the bloods show?
- amylase will be raised but not astronomically like pancreatitis
what will an x-ray show?
- will show excess gas and air under the diaphragm
when is a gastrograffin swallow used?
o For suspected oesophageal perforations
how to manage an acute case of GI perforation?
o Correct fluid and electrolytes
o IV antibiotics
how to surgically manage a large bowel perforation?
- Identify site of perforation
- Peritoneal lavage
- Resection of perforated section
