Gastrointestinal Perforation

Question 1

What is GI perforation?

Answer 1

A hole in the wall of any part of the GI tract

Can occur in the stomach, small intestine, large bowel, or rectum.

Question 2

What are common causes of GI perforation?

Answer 2

• appendicitis
• diverticulitis
• Crohn’s disease
• peptic ulcers

Question 3

What are the clinical presentations of GI perforation?

Answer 3

• severe abdominal pain
• signs of sepsis
• acute abdomen on examination

Question 4

How is GI perforation diagnosed?

Answer 4

Erect chest x-ray showing free air under diaphragm & CT scan

Question 5

What is the management for GI perforation?

Answer 5

• surgical intervention
• broad-spectrum antibiotics

Question 6

What is a perforated peptic ulcer?

Answer 6

A rare but serious complication of peptic ulcer disease

It involves complete erosion of an existing peptic ulcer.

Question 7

What happens during the pathophysiology of a perforated peptic ulcer?

Answer 7

• Complete erosion of an existing peptic ulcer through the wall of the viscus into the peritoneal cavity
• Gastric contents exit the stomach or duodenum, leading to chemical peritonitis

Question 8

What is the classic triad of symptoms in a perforated peptic ulcer?

Answer 8

• abdominal pain
• tachycardia
• abdominal rigidity

Question 9

What are the common symptoms of a perforated peptic ulcer?

Answer 9

• very severe, constant abdominal pain
• abdominal distension
• nausea and vomiting
• dyspepsia
• constipation
• Kehr’s sign (shoulder tip pain)

Question 10

What are the clinical signs associated with a perforated peptic ulcer?

Answer 10

• abdominal tenderness
• peritonitis (guarding, rigidity, rebound tenderness)
• fever
• tachycardia

Question 11

What investigations are used for diagnosing a perforated peptic ulcer?

Answer 11

• erect chest x-ray (free air under diaphragm)
• CT abdomen (free fluid in peritoneal cavity)

Question 12

What are the differential diagnoses for a perforated peptic ulcer?

Answer 12

• pancreatitis
• bleeding peptic ulcer
• perforated oesophagus
• Mallory-Weiss tear
• cholecystitis

Question 13

What are the management steps for a perforated peptic ulcer?

Answer 13

• initial resuscitation (ABCDE)
• IV fluids
• NG tube insertion
• IV PPI
• antibiotics
• non-operative management if stable
• operative management if continued deterioration

Question 14

What complications can arise from a perforated peptic ulcer?

Answer 14

• sepsis
• significant haemorrhage
• post-operative leakage