Gastrointestinal perforation Flashcards
1
Q
Define
A
Hole in the wall of part of the gastrointestinal tract
2
Q
Aetiology/risk factors
A
Underlying causes include:
- Gastric ulcers
- Duodenal ulcers
- Appendicitis
- Gastrointestinal cancer
- Diverticulitis
- Inflammatory bowel disease
- Superior mesenteric artery syndrome
- Trauma
- NSAIDs
- Typhoid
3
Q
epidemiology
A
Children: blunt trauma
Adults:
Duodenal perforation more than gastric perforation
4
Q
symptoms
A
- History of penetrating issue
- NSAID or aspirin use
- Abdominal pain
- Vomiting
- Hiccuping
- History of travel
- Sharp severe sudden onset (perf peptic ulcer)
5
Q
signs
A
very unwell signs of shock pallor pyrexia dehydration peritonitis loss of dullness (gas covers)
6
Q
investigations
A
- Bloods: WCC, CRP, Cultures, Group & Save, Cross Match, Amylase to rule out pancreatitis, ABG, LFT
- Urinalysis
- USS: Localised gas collection, thickens bowel loop
- CT: If no delay
- Plain AXR: Rigler’s sign, Visible falciform ligament RUQ -> umbilicus
- CXR if peritonitic or over 50: gas under diaphragm
7
Q
management
A
Laparoscopy
Laparotomy
correct iv fluids and electrolytes
iv antibiotics
8
Q
complications
A
Bleeding
- Sepsis
- Bowel infarction
large and small bowel - peritonitis
oesophageal - sepsis death and mediastinitis
9
Q
prognosis
A
Chances of recovery improve with early diagnosis and treatment
