Disorders Of Upper Gi

Question 1

What investigations are done for duodenum perforation

Answer 1

CXR
AXR
WCG
Crp
Wcc
Lfts

Question 2

Why do we do CXR AXR for duodenal perforation

Answer 2

• Want to see if they have air under diaphragm in CXR
• Want to look for free air in AXR but also to check small and large bowel

Question 3

What do you see in perforated duodenum

Answer 3

• Rigler’s sign- free intraperitoneal air (right pic)
• Free subdiaphragmatic air (left pic)

Question 4

How do we manage peritonitis pre-operatively then operatively?

Answer 4

Pre-operatively

• Put NG tube in to empty gastric contents to stop them leaking into abdomen
• NBM or else anything that goes in will go through the hole
• IV fluids
• Antibiotics

Operatively

• Identify aetiology of peritonitis (where hole is)
• Eradication of peritoneal source of contamination
• Peritoneal lavage and drainage

Question 5

What are the common sites of perforation for duodenal ulcers?

Answer 5

• Most commonly anterior/superior surface of first part of duodenum or pylorus- anterior ulcers typically perforate at D1
• Rarely on pre-pyloric antrum
• Less frequently in stomach (lesser curvature, fundus)
• Rarely found on posterior surface of first part of duodenum or the stomach
• Duodenal perforation is 10x more frequent than gastric perforation

Question 6

What is the problem with posterior duodenal ulcers?

Answer 6

These are retroperitoneal and can perforate into arteries and bleed

Especially gastroduodenal artery which is a big one

Question 7

What is a laparoscopic omental patch?

Answer 7

We take a bit of omentum and stitch it on top of perforation- not too tight or else it’ll make duodenum ischaemic

Then lavage and clean it a lot to get rid of any contamination which could later become infected

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Question 8

Gallstone pancreatitis