Gastrointestinal Perforation Flashcards
Define Gastrointestinal Perforation?
Perforation of the wall of the GI tract with spillahe of bowel contents
What is the aetiology of Large Bowel perforation?
COMMON:
- Diverticulitis
- Colorectal Cancer
- Appendicitis
Others: volvulus, UC (toxic megacolon)
What is the aetiology of Gastroduodenal perforation?
COMMON:
Perforated duodenal or gastric ulcer
Others: gastric cancer
What is the aetiology of Small Bowel perforation (RARE)?
Trauma
Infection (E.g. TB)
Crohn’s Disease
What is the Oesophageal cause of Gastrointestinal Perforation?
Boerhaave’s perforation - rupture of the oesophagus following forceful vomiting
What are the risk factors of Gastrointestinal Perforation?
Risk factors of cause (e.g. gastroduodenal - NSAIDs, steroids, bisphosphonates)
What is the epidemiology of Gastrointestinal Perforation?
Incidence depends on cause
What are the presenting symptoms of Gastrointestinal Perforationbased on?
Depends on CAUSE
What are the presenting symptoms of Large Bowel perforation?
Peritonitic abdominal pain
IMPORTANT: make sure you rule out ruptured AAA
What are the presenting symptoms of Gastroduodenal perforation?
Sudden-onset severe epigastric pain - worse on movement
Pain becomes generalised
Gastric malignancy - may have accompanying weight loss and nausea/vomiting
What are the presenting symptoms of Oesophageal perforation?
Severe pain following an episode of violent vomiting
Neck/chest pain and dysphagia develop soon afterwards
What are the signs of Gastrointestinal Perforation on clinical examination?
Very unwell Signs of shock Pyrexia Pallor Dehydration Signs of peritonitis Loss of liver dullness (due to overlying gas)
What are the signs of peritonitis on clinical examination?
Guarding
Rigidity
Rebound tenderness
Absent bowel sounds
What bloods do you do for Gastrointestinal Perforation?
FBC
U&E
LFTs
Amylase
Why do we do Amylase for Gastrointestinal Perforation?
Will be reaised with perforation (but shouldn’t be astronomical (as seen in pancreatitis))
Why do we do an Erect CXR for Gastrointestinal Perforation?
Shows air under the diaphragm
Why do we do an AXR for Gastrointestinal Perforation?
Shows abnormal gas shadowing
Why do we do a Gastrograffin Swallow for Gastrointestinal Perforation?
For suspected oesophageal perforations
What is the general management plan for Gastrointestinal Perforation?
Correct fluid and electrolytes IV antibiotics (with anaerobic cover)
What is the surgical management plan for Large Bowel perforation?
Identify site of perforation
Peritoneal lavage
Resection of perforated section (usually as part of a Hartmann’s procedure)
What is the surgical management plan for Gastroduodenal perforation?
Laparotomy
Peritoneal Lavage
Perforation is closed with an omental patch
Gastric ulcers are biopsied
H. Pylori eradication if positive for H.Pylori
What is the surgical management plan for oesophageal perforation?
Pleural lavage
Repair of ruptured oesophagus
What are the complications of Large and Small bowel perforation?
Peritonitis
What are the complications of Oesophageal Perforation?
Mediastinitis, shock, overwhelming sepsis and death
What is the prognosis for patients with gastroduodenal perforation?
Gastric ulcers have higher morbidity and mortality than duodenal ulcers
Poor prognosis for perforated gastric carcinomas
What is the prognosis for patients with Large Bowel perforation?
High risk of faecal peritonitis if left untreated
This can lead to death from septicaemia and multiorgan failure
