Abdominal: Perforated Viscus (brief) Flashcards
what is a perforated viscus?
erforation of gastrointestinal wall with subsequent leakage of enteric contents
what might cause a perforated viscus?
Direct trauma (e.g. foreign bodies) tissue ischemia (infections) necrosis (peptic ulcers)
A perforated viscus can occur at any site of the GI tract, but where is the most common site?
stomach or small intestine
what risk factors may contribute to a perforated viscus?
- diverticulitis
- peptic ulcers
- gallstones
- IBD
- Cancer
- Blunt trauma
- previous abdo surgery
- ingestion of foreign objects
- oesophagitis
what are clinical features of a perforated viscus?
- pain (rapid onset, sharp in nature)
- systemically unwell
- malaise
- vomiting
- lethargy
- dizziness
- low BP
- tachycardia
- Abdo distension
- passing less urine, stools or gas
- SOB
what are the complications of a perforated viscus?
infection (peritonitis and sepsis) and haemorrhage, with incidence depending on the site involved.
what differential diagnosis could you offer for a perforated viscus?
Acute pancreatitis.
Myocardial infarction.
Tubo-ovarian pathology.
Ruptured aortic aneurysm.
what type of pain is felt with. a perforated viscus?
rapid onset
sharp in nature
what investigations would you conduct to diagnose a perforated viscus?
- Bloods
- CT scan
- Abdo XR
why would you prefer a CT scan over an chest/abdoXR with a suspected perforated viscus?
The sensitivity in detecting perforation on XR is around 70%, meaning 3 out of every 10 patients with a gastrointestinal perforation will have no signs on plain film radiograph
what is the immediate treatment for a perforated viscus?
- broad spectrum antibiotics
- NBM
- NG tube
- IV fluids
what is the surgical treatment for a perforated viscus?
Repairing perforated peptic ulcer with an omental patch, resecting a perforated diverticulae (e.g. via a Hartmann’s procedure),
NB: ensure thorough wash out
