Gastrointestinal Perforation Flashcards

1
Q

Define Gastrointestinal Perforation?

A

Perforation of the wall of the GI tract with spillahe of bowel contents

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2
Q

What is the aetiology of Large Bowel perforation?

A

COMMON:

  • Diverticulitis
  • Colorectal Cancer
  • Appendicitis

Others: volvulus, UC (toxic megacolon)

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3
Q

What is the aetiology of Gastroduodenal perforation?

A

COMMON:
Perforated duodenal or gastric ulcer
Others: gastric cancer

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4
Q

What is the aetiology of Small Bowel perforation (RARE)?

A

Trauma
Infection (E.g. TB)
Crohn’s Disease

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5
Q

What is the Oesophageal cause of Gastrointestinal Perforation?

A

Boerhaave’s perforation - rupture of the oesophagus following forceful vomiting

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6
Q

What are the risk factors of Gastrointestinal Perforation?

A

Risk factors of cause (e.g. gastroduodenal - NSAIDs, steroids, bisphosphonates)

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7
Q

What is the epidemiology of Gastrointestinal Perforation?

A

Incidence depends on cause

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8
Q

What are the presenting symptoms of Gastrointestinal Perforationbased on?

A

Depends on CAUSE

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9
Q

What are the presenting symptoms of Large Bowel perforation?

A

Peritonitic abdominal pain

IMPORTANT: make sure you rule out ruptured AAA

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10
Q

What are the presenting symptoms of Gastroduodenal perforation?

A

Sudden-onset severe epigastric pain - worse on movement
Pain becomes generalised
Gastric malignancy - may have accompanying weight loss and nausea/vomiting

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11
Q

What are the presenting symptoms of Oesophageal perforation?

A

Severe pain following an episode of violent vomiting

Neck/chest pain and dysphagia develop soon afterwards

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12
Q

What are the signs of Gastrointestinal Perforation on clinical examination?

A
Very unwell
Signs of shock
Pyrexia
Pallor 
Dehydration
Signs of peritonitis 
Loss of liver dullness (due to overlying gas)
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13
Q

What are the signs of peritonitis on clinical examination?

A

Guarding
Rigidity
Rebound tenderness
Absent bowel sounds

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14
Q

What bloods do you do for Gastrointestinal Perforation?

A

FBC
U&E
LFTs
Amylase

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15
Q

Why do we do Amylase for Gastrointestinal Perforation?

A

Will be reaised with perforation (but shouldn’t be astronomical (as seen in pancreatitis))

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16
Q

Why do we do an Erect CXR for Gastrointestinal Perforation?

A

Shows air under the diaphragm

17
Q

Why do we do an AXR for Gastrointestinal Perforation?

A

Shows abnormal gas shadowing

18
Q

Why do we do a Gastrograffin Swallow for Gastrointestinal Perforation?

A

For suspected oesophageal perforations

19
Q

What is the general management plan for Gastrointestinal Perforation?

A
Correct fluid and electrolytes 
IV antibiotics (with anaerobic cover)
20
Q

What is the surgical management plan for Large Bowel perforation?

A

Identify site of perforation
Peritoneal lavage
Resection of perforated section (usually as part of a Hartmann’s procedure)

21
Q

What is the surgical management plan for Gastroduodenal perforation?

A

Laparotomy
Peritoneal Lavage
Perforation is closed with an omental patch
Gastric ulcers are biopsied
H. Pylori eradication if positive for H.Pylori

22
Q

What is the surgical management plan for oesophageal perforation?

A

Pleural lavage

Repair of ruptured oesophagus

23
Q

What are the complications of Large and Small bowel perforation?

A

Peritonitis

24
Q

What are the complications of Oesophageal Perforation?

A

Mediastinitis, shock, overwhelming sepsis and death

25
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
26
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