Gastrointestinal Perforation Flashcards
Is an oesophageal perforation an emergency.
Yes, it is a surgical emergency.
What are some causes of an oesophageal perforation. (5)
OGD (increased risk if dilatation or biopsy performed). Foreign body. Carcinoma. External trauma. Post-emesis (Boerhaave's syndrome).
What are the symptoms of an oesophageal perforation. (2)
Chest pain.
Odynophagia.
What are the clinical signs of an oesophageal perforation. (3)
Shock (tachycardia, tachypnoea, hypotension).
Surgical emphysema of neck/chest (air in tissues - produces a ‘crackling’ sensation on palpation and is visible on Xray).
Fever/signs of systemic sepsis will rapidly develop if undiagnosed.
What sort of strictures are most likely to get perforated. (3)
Malignant strictures.
Corrosive strictures.
Post-radiotherapy strictures.
What type of strictures can get perforated when performing an endoscopy. (4)
Malignant strictures.
Corrosive strictures.
Post-radiotherapy strictures.
Peptic strictures.
What is Boerhaave’s syndrome.
Spontaneous oesophageal perforation, resulting from forceful vomiting and retching.
Why is shock a clinical features of an oesophageal perforation. (2)
Blood loss.
Occurs as the oesophageal-gastric contents enter the mediastinum and thoracic cavity.
What are potential complications of oesophageal perforations. (3)
Subcutaneous emphysema.
Pleural effusions.
Pneumothorax.
What is seen on an CXR in a patient with Boerhaave syndrome. (3)
Widened mediastinum.
Air in the mediastinum or subcutaneous air.
A pleural effusion may be present.
Why might a pleural effusion be present in a patient with Boerhaave syndrome.
Due to the irritation from the luminal contents.
What is a mallory-weiss tear.
Partial thickness oesophageal laceration caused by forceful retching.
What causes a mallory-weiss tear. (2)
After alcohol consumption.
Bulimia.
What are the clinical presentations of a mallory-weiss tear. (2)
Painful, blood streaked emesis.
