Gastrointestinal perforation

Question 1

what is a GI perforation

Answer 1

perforation of the wall which causes spillage of bowel contents

Question 2

where can perforation occur

Answer 2

large bowel, gastroduodenal, small bowel (rare to be perforated) and oesophagus

Question 3

common causes of large bowel perforation

Answer 3

diverticulitis, colorectal cancer, appendicitis

Question 4

common causes of gastroduodenal perforation

Answer 4

duodenal perforated or gastric ulcer/ cancer

Question 5

common causes of small bowel perforations

Answer 5

trauma, infections (SUCH AS TB), crohn’s disease

Question 6

common causes of oesophageal perforation

Answer 6

boerhaave’s perforation

Question 7

what can cause boerhaaves perforation

Answer 7

rupture of the oesophageal lining due to forceful vomitting

Question 8

risk factors

Answer 8

risk factors of the cause

Question 9

presenting symptoms of large bowel perforation

Answer 9

peritonitis abdominal pain (remember to rule out an abdominal aortic aneurysm)

Question 10

gastroduodenal perforation presenting symptoms

Answer 10

sudden-onset severe epigastric pain

gastric malignancy may present with weight loss, fatigue and nausea&vomitting

Question 11

signs of GI perforation on physical examination

Answer 11

very sick patient,
signs of shock,

pyrexia,

pallor,

dehydration,

signs of peritonitis

loss of liver dullness on percussion

Question 12

some signs of peritonitis

Answer 12

guarding, rigidity, rebound tenderness and absent bowel sounds

Question 13

invesigtstions to do for GI perforation

Answer 13

bloods (LFT’s, FBC and U&E’s)

erect chest X-ray (pneumoperitoneum)

AXR (abnormal gas shadowing)

Question 14

management

Answer 14

in the acute setting, resuscitation, IV fluids and IV antibiotics

Question 15

surgical management of GI perforation

Answer 15

depends on cause (large bowel, oesophageal or small bowel)