Oesophageal Perforation Flashcards
What is an Oesophageal rupture?
Oesophageal Rupture is a transmural tear of the oesophageal wall, Boerhaave’s syndrome is an oesophageal rupture due to vomiting. It is different from Mallory Weiss tear which is only a tear of the mucosa.
What are the causes of Oesophageal rupture?
Trauma, Vomiting (Commonly alcohol or bulimia), Corrosive Ingestion, Oesophageal Carcinoma, Iatrogenic (Endoscopy, Biopsy)
What will you find on a history taking of Oesophageal rupture?
Symptoms:
Triad of vomiting, chest pain and subcutaneous emphysema
Patient will be very ill – Hypotensive, Shock, Near Death
Risk Factors:
Recent Iatrogenic procedure
Recurrent Vomiting
What will you find on a examination of Oesophageal rupture?
End of the bed: Fever - Rupture goes onto cause mediastinitis or sepsis Neck Surgical Emphysema Chest: Surgical Emphysema Tachypnoea Dyspnoea Hypotension Listen for a pleural effusion
What investigations will you order in an Oesophageal rupture?
Bedside:
Full set of Observations
ECG – They are very ill and Pre-operative workup
Bloods:
FBC - Anaemia if bleeding, infection if mediastinitis
U&E - May need surgery and looking for dehydration due to bleed
LFT – Pre-Operative Bloods
Imaging:
CXR – Looking for enlarged mediastinum and for any pleural effusion that can occur
CT – Identifying the rupture, may not have time for this
What is the treatment of an Oesophageal rupture?
Resuscitation:
A-E approach
Get IV Access (2 wide bore cannulas)/Give O2 to maintain sats of 94+ /Attach 12 lead ECG
Make sure not to use saline in liver disease
Insert Urinary Catheter
Assessment with AMPLE history and brief examination
Get help - Medical reg on call/consider ITU if large bleed
Frequent Observations - Constant or 15 minutely
Transfusion with O- Blood or Cross matched blood if Hb<70
Transudes with Platelets if platelet count >50
Keep Nil by mouth
Prophylactic antibiotics
Surgery:
Refer for surgical repair if caught early
May require draining and diversion if too acute to repair
