gastrointestinal perforation Flashcards

1
Q

define gastrointestinal perforation?

A

perforation of the wall of the GI tract with spillage of bowel contents

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2
Q

what are the causes of large bowel perforation?

A
  • Diverticulitis
  • Colorectal cancer
  • Appendicitis
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3
Q

what are the causes of gastroduodenal perforation?

A

• Perforated duodenal or gastric ulcer

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4
Q

what are the causes of small bowel perforation?

A

o Trauma
o Infection (e.g. TB)
o Crohn’s disease

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5
Q

what are the causes of oesophagus perforation?

A

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

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6
Q

what are the presenting symptoms of large bowel perforation?

A

o Peritonitic abdominal pain

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7
Q

what are the presenting symptoms of gastroduodenal perforation?

A

o Sudden-onset severe epigastric pain

o Pain becomes generalised

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8
Q

what are the presenting symptoms of oesophageal perforation?

A

o Severe pain following an episode of violent vomiting
o May be haemoptysis
o Neck/chest pain and dysphagia develop soon afterwards

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9
Q

signs of GI perforation?

A
  • Very UNWELL
  • Signs of shock
  • Pyrexia
  • Pallor
  • Dehydration
  • Signs of peritonitis
  • Loss of liver dullness
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10
Q

identify investigations for GI perforation?

A

Bloods
Erect CXR
AXR
gastrograffin swallow

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11
Q

what will the bloods show?

A
  • amylase will be raised but not astronomically like pancreatitis
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12
Q

what will an x-ray show?

A
  • will show excess gas and air under the diaphragm
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13
Q

when is a gastrograffin swallow used?

A

o For suspected oesophageal perforations

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14
Q

how to manage an acute case of GI perforation?

A

o Correct fluid and electrolytes

o IV antibiotics

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15
Q

how to surgically manage a large bowel perforation?

A
  • Identify site of perforation
  • Peritoneal lavage
  • Resection of perforated section
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16
Q

how to surgically manage a gastroduodenal perforation?

A
  • Laparotomy
  • Peritoneal lavage
  • Perforation is closed with an omental patch
  • Gastric ulcers are biopsied
  • Helicobacter pylori eradication if positive for H. pylori
17
Q

how to surgically manage a oesophageal perforation?

A
  • Pleural lavage

* Repair of ruptured oesophagus

18
Q

complications of large and small bowel perforations?

A

peritonitis

19
Q

complications of oesophageal perforations?

A

mediastinitis, shock, overwhelming sepsis and death

20
Q

prognosis for patients with gastroduodenal perforation?

A

o Gastric ulcers have higher morbidity and mortality than duodenal ulcers
o POOR prognosis for perforated gastric carcinomas

21
Q

prognosis for patients with large bowel perforation?

A

o High risk of faecal peritonitis if left untreated

o This can lead to DEATH from septicaemia