Chapter 39: UGI Bleed- Boerhaave's Syndrome Flashcards

1
Q

What is it?

A

Postemetic esophageal rupture

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2
Q

Why is the esophagus susceptible to perforation and more likely to
break down an anastomosis?

A

No serosa

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3
Q

What is the most common location?

A

Posterolateral aspect of the esophagus the left), 3 to 5 cm above the GE junction

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4
Q

What is the cause of rupture?

A

Increased intraluminal pressure, usually caused by violent retching and vomiting

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5
Q

What is the associated risk factor?

A

Esophageal reflux disease (50%)

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6
Q

What are the symptoms?

A

Pain postemesis (may radiate to the back, dysphagia)

(Think Boerhaave’s = Boer HEAVES)

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7
Q

What are the signs?

A
  1. Left pneumothorax
  2. Hamman’s sign
  3. left pleural effusion,
  4. subcutaneous/mediastinal emphysema
  5. fever
  6. tachypnea
  7. tachycardia
  8. signs of infection by 24 hours
  9. neck crepitus
  10. widened mediastinum on CXR
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8
Q

What is Mackler’s triad?

A
  1. Emesis
  2. Lower chest pain
  3. Cervical emphysema (subQ air)
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9
Q

What is Hamman’s sign?

A

“Mediastinal crunch or clicking” produced by the heart beating against air-filled tissues

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10
Q

How is the diagnosis made?

A
  • History
  • physical examination
  • CXR
  • esophagram with water-soluble contrast
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11
Q

What is the treatment?

A

Surgery within 24 hours to drain the mediastinum and surgically close the perforation and placement of pleural patch; broad-spectrum antibiotics

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12
Q

What is the mortality rate if >24 hours until surgery for perforated
esophagus?

A

≈33%

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13
Q

Overall, what is the most common cause of esophageal perforation?

A

Iatrogenic (most commonly cervical esophagus)

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14
Q

45-year-old male with dark blood per rectum, NGT returns clear
fluid and no bile

A

EGD to rule out UGI source

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15
Q

40-year-old s/p MVC with severe liver injury on hospital day 3
develops significant UGI bleed; EGD reveals no ulcer or gastritis

A

Hemobilia

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