GI Perforation Flashcards
What is GI Perforation?
Perforation of the wall of the GI tract with spillage of bowel contents
Give 2 common causes of GI perforation
Peptic ulcers
Sigmoid diverticulum
What mnemonic can be used to remember causes of large bowel perforation?
CAD UV Colorectal cancer Appendicitis Diverticulitis UC Volvulus
Give 3 causes of small bowel perforation
Trauma
Infection (e.g. TB)
Crohn’s disease
What may cause oesophageal perforation?
Boerhaave’s perforation: rupture of oesophagus following forceful vomiting
Give 2 causes of gastroduodenal perforation
Perforated duodenal or gastric ulcer
Others: gastric cancer
What are the risk factors for GI perforation?
Risk factors of cause (e.g. gastroduodenal: NSAIDs, steroids, bisphosphonates)
Describe the epidemiology of GI perforation
Large bowel: common
Gastroduodenal: common
Small bowel: rare
Name a symptom of large bowel perforation. Thus, what differential should be excluded?
Peritonitic abdo pain
Exclude ruptured AAA
Give 2 symptoms of oesophageal perforation
Severe pain following an episode of violent vomiting
Neck/ chest pain + dysphagia develop soon afterwards
List 3 symptoms of gastroduodenal perforation
Sudden-onset severe epigastric pain: worse on movement
Pain becomes generalised
Gastric malignancy: may have weight loss + N+V
List 7 signs of GI perforation
Very UNWELL
Signs of shock
Pyrexia
Pallor
Dehydration
Signs of peritonitis (guarding, rigidity, rebound tenderness, absent BS)
Loss of liver dullness (due to overlying gas)
What scoring system is used to predict adverse outcomes following a GI perforation?
Rockall Score
Score >8 indicates a 40% risk of mortality.
What bloods are taken in suspected GI perforation?
FBC: neutrophilic leukocytosis
U+E: urea + creatinine raised
Amylase: raised (not hugely (as in pancreatitis))
ABG: Lactatic acidosis (if ischaemia)
What is the prognosis of large bowel perforations?
High risk of faecal peritonitis if left untreated
Can lead to DEATH from septicaemia + multiorgan failure