Gastrointestinal perforation Flashcards
What is gastrointestinal perforation?
Complete penetration of any part of the wall of the GI tract resulting in intestinal contents entering the abdominal cavity.
What are the causes of gastrointestinal perforation? (x7)
o Trauma
o Colonoscopy, ERCP etc.
o Bowel obstruction such as volvulus, bowel cancer
o Diverticulitis
o Gastric or duodenal ulcers
o Infections e.g. C. difficile
o Appendicitis
o IBD
o Gall bladder disease
What are the risk factors for gastrointestinal perforation? (x3)
Smoking, alcohol, NSAIDs
What are the symptoms of gastrointestinal perforation? (x4)
Severe sudden-onset abdominal pain (worse in palpation and movement), fever, N&V, haematemesis (vomiting blood).
What is the pattern of pain when there is intestinal perforation?
Pain starts from site of perforation, then spreads across the abdomen.
What are the symptoms when a gastric ulcer is the cause of perforation? (x3)
Burning pain in epigastrium, flatulence and dyspepsia (reflux).
What is the pattern of pain when a duodenal ulcer is the cause of perforation?
Sudden epigastric pain, R of midline.
What are the signs of gastrointestinal perforation? (x6)
o Abdomen becomes rigid with tenderness and rebound tenderness.
o After some time, the abdomen becomes silent (ileus; heart sounds are heard all over) – no bowel sounds, patient stops passing flatus.
o Abdomen is distended.
o Sepsis
o Tachycardia
o Tachypnoea
What are the investigations for gastrointestinal perforation? (x3)
o Bloods: increased WCC
o CT: typical method of diagnosis
o Erect CXR: air from a perforation under the diaphragm
How would pneumoperitoneum be visualised on a supine AXR? (x3)
Gas on both sides of the bowel wall (Rigler’s sign), a triangle of gas in the RUQ trapped beneath the falciform ligament, a circle of gas beneath the anterior abdominal wall.
How is gastrointestinal perforation managed? (x1 and x4)
o SURGICAL: in the form of an exploratory laparotomy, closure of perforation, and peritoneal wash. Can be managed laparoscopically but rare.
o CONSERVATIVE: IV fluids, antibiotics, nasogastric aspiration and bowel rest (NBM) only in patients who are clinically stable and nontoxic.
What is a Graham patch?
Piece of omentum is used to cover and close duodenal perforations, 5mm or less.
What are the complications of gastrointestinal perforation?
Peritonitis and sepsis
What is the prognosis for patients with gastrointestinal perforation?
Emergency surgery is required. Prognosis worsens if patients with sepsis with mortality from 11-81% - fuck me.
