GI perf + peritonitis Flashcards
causes of GI perforation, where can it occur
can occur at any point along the GI canal.
Upper GI: peptic ulcer, gastric cancer, oesophageal cancer, foren body, excessive vomit.
Lower GI: diverticulitis, colorectal ca, appendicitis, foreign body, cholitis/ chrons, toxic megacolon.
Any: trauma, iatrogenic, mesenteric ischaemia, obstructing lesions/ obstruction.
ischaemic, infective, erosive, traumatic.
clinical features signs + symptoms of GI perf
rapid onset severe abdo pain. nausea, vom, fever.
rigid abdomen (feature of peritonitis)
look unwell- features of sepsis.
mostly dependant on underlying cause.
Air under diaphragm on CXR. Riglers sign, psoas sign abdo XR.
may be following medical interventino, chaemo, trauma.
reduced bowel signs, abdo guarding, rebound tenderness, distension
investigations of GI perf, prognosis
blood tests- primerily for inflamatory markers (WCC, CRP) - may show organ dysfunction (AKI, coagulopathy)
imaging is CT with IV contrast- gold standrad. confirm the presence of free air. -
in upper can use oral contrast.
XR only 70% sensitive.
prognosis entirely dependent on extent, or perf and degree of intraabdo contamination
management of GI perf.
got to be rapid diagnosis and Rx, these patients are sick.
Broad spectrum Abx, NBM, NG if needed. IV fluids and analgesia. rapid resus may be needed
individualised surgery after this point- repair and control contamination.
very few pts managed conservatively- no contamination, small perf, well. or not going to survive surgery.
define peritonitis
if an infection in the intraabdominal cavity has a primary focus/ identifiable location it is called an abcess.
if the nidus of the inflam response occurs in the serous membrane lining the cavity it is called peritonitis.
both can lead to peritonitis induced sepsis.
common causes of peritonitis
‘violation’ of the GI viscera along its track. (due either to chronic processes- think ulcer, or acute processes- think acute pancreatitis)
signs and syptoms of peritonitis
prostration, shock, lying still, +ve cough test, tenderness, abdominal rigidity (‘board like’) guarding + and no bowel sounds.
N+V, anorexia, reducing abdominal wall tension. fever.
errect (must have been for 10 mins) gas under diaphragm on abdo XR.
management of peritontis
identification and targeted treatment of offending agent
dont rush to theatre- resusitate appropriately.
surgical wash out is often performed, broad spectrum abx also used. remove septic foci, remove necrotic tissue, drain purulent material.
CT/US guided abcess drainage
manage the host response to sepsis.
diagnosis of peritonitis
generally a clinical diagnoiss
CT only delays inevitable surgical management. elevated white cell count
ABG for metabolic acidosis
urinalysis for r/o urinary causes
discuss spontaneous bacterial peritonitis
in a patient with ascites who deteriorates suddently consider
common causatives are E.Coli, klebsiella, streptococci,
piperacillin, tazobactam.
an immune system deficiency which bacteria spread to peritoneum.
