Gastrointetsinal perforation

Question 1

What is a GI perforation

Answer 1

medical emergency occurs when hole/tear develops in wall of GI tract

Question 2

What are some common causes

Answer 2

peptic ulcer disease
diverticulitis
GI cancer
IBD
trauma
foreign body ingestion
Boerhaaves syndrome

Question 3

What would someone with a GI perforation present with

Answer 3

• sudden onset,severe abdominal pain which may be diffuse or localised to a specific area
• nausea and vomitting
  -fever
  -signs of shock - tachycardia, hypotension and tachypnoea

patients are systemically unwell

Question 4

What may someone have on examination

Answer 4

-abdominal distension
-tenderness
-guarding
-rebound tenderness

SEVERE CASES
-peritonitis
-rigidity, board like abdomen
-absent bowel sounds

Question 5

What investigations are carried out

Answer 5

Abdominal X-ray - may show free air under diaphragm / within abdominal cavity

Erect CXR if acute upper abdominal pain

CT/US may be used to confirm diagnosis

CT SCAN WITH IV CONTRAST confirms diagnosis

FBC, electrolyte panel, blood cultures may be used to assess for sepsis

Question 6

What is the manegement

Answer 6

• anyone with suspected/confirmed GI perforation should be admitted to hospital and managed with a surgeon

-treatment can include IV fluids, broad spectrum Abx and analgesia

Question 7

What surgical intervention may be needed

Answer 7

exploratory laparotomy
- to remove perforation/ any necrotic tissue

Question 8

What is Boerhaaves syndrome

Answer 8

spontaneous rupture of esophagus that occurs after repeated episodes of omitting

Question 9

Where usually is the rupture in the oesophagus

Answer 9

distally sited on the left hand side

Question 10

What does Boerhaave’s syndrome usually present with

Answer 10

MACKLER TRIAD

triad of vomitting, severe retrosternal chest pain which typically radiates to back and subcutaneous emphysema

Question 11

How is the subcutaneous emphysema usually diagnosed

Answer 11

suprasternal crepitus felt upon palpation in patient

Question 12

How do you diagnose Booerhaaves syndrome

Answer 12

CT contrast swallow

Question 13

How do you treat Boerhaaves syndrome

Answer 13

thoractomy and lavage
if less than 12 hours primary repair is usually feasible

more than 12 hours besty managed by insertion of a T tube

Delays beyond 24 hours =high mortality rate

Question 14

What are some complications of Boeerhaaves syndrom

Answer 14

• severe sepsis secondary to mediastinitis