Gastrointestinal perforation

Question 1

Gastrointestinanl perforation

Answer 1

full-thickness loss of bowel integrity resulting in perforation peritonitis. most common cause is perforation of duodenal ulcer.

Question 2

symptoms

Answer 2

acute onset of severe abdominal pain associated with nausea, vomitng, fever, obstipation, tachycardia, tachypnoea, hypotension
peritonitis
shock
loss of liver dullness on RUQ percussion
decreased bowel sounds, diffuse or localised abdominal guarding, rebound tenderness

Question 3

investigations

Answer 3

bloods:
FBC- neutrophillis leukocytosis
BMP, BUN, creatinine
ABG- lactic acid

imaging:
abdominal CT with IV contrast.
confirm presence of free air in the peritoneal cavity (pneumoperitoneum)

Xray (upright) pneumoperitoneum

USS abdomen

emergency exploratory laparotomy

Question 4

pneumoperitoneum

Answer 4

presence of air in the peritoneal cavity. abdominal X-ray shows radiolucent air under the diaphragm or the delineation of bowel wall by radiolucent air.

can occur after perforation of a hollow abdominal viscus (peptic ulcer) or surely which air is introduced to the abdominal cavity.

Question 5

management

Answer 5

if no signs of sepsis / well contained perforation (small localised appendicular or diverticular perforation)= conservative management with antibiotics, bowel rest, close monitoring of vital signs, abdominal examiantion

• bowel rest
• IV abx
• IV fluid
• surgery
• analgesics
• antiemetics
• NG tube
• IV PPI

Question 6

causes of gastrointestinal pefroatioon

Answer 6

1. ulcerative/erosive disease
peptic ulcer
stomach/duodenal ulcer
malignancy
IBD/UC/Chron's

2. infection
diverticulitis
acute appendicitis
typhoid
GI tuberculosis
toxic megacolon

3. bowel ischaemia
   bowel obstruction (Adhesions, Volvos, malignancy)
   acute mesenteric ischaemia
4. trauma
   penetrating (Stab)
   blunt

5. other
foreign body ingestion
drug induced (NSAIDs, glucocorticoids, cocaine)
radiation therapy
post renal transplant