GI Perforation Flashcards

1
Q

What is GI Perforation?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give 2 common causes of GI perforation

A

Peptic ulcers

Sigmoid diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What mnemonic can be used to remember causes of large bowel perforation?

A
CAD UV
Colorectal cancer  
Appendicitis  
Diverticulitis  
UC
Volvulus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give 3 causes of small bowel perforation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What may cause oesophageal perforation?

A

Boerhaave’s perforation: rupture of oesophagus following forceful vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give 2 causes of gastroduodenal perforation

A

Perforated duodenal or gastric ulcer

Others: gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the risk factors for GI perforation?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the epidemiology of GI perforation

A

Large bowel: common
Gastroduodenal: common
Small bowel: rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name a symptom of large bowel perforation. Thus, what differential should be excluded?

A

Peritonitic abdo pain

Exclude ruptured AAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give 2 symptoms of oesophageal perforation

A

Severe pain following an episode of violent vomiting

Neck/ chest pain + dysphagia develop soon afterwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List 3 symptoms of gastroduodenal perforation

A

Sudden-onset severe epigastric pain: worse on movement
Pain becomes generalised
Gastric malignancy: may have weight loss + N+V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List 7 signs of GI perforation

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What scoring system is used to predict adverse outcomes following a GI perforation?

A

Rockall Score

Score >8 indicates a 40% risk of mortality.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What bloods are taken in suspected GI perforation?

A

FBC: neutrophilic leukocytosis
U+E: urea + creatinine raised
Amylase: raised (not hugely (as in pancreatitis))
ABG: Lactatic acidosis (if ischaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the prognosis of large bowel perforations?

A

High risk of faecal peritonitis if left untreated

Can lead to DEATH from septicaemia + multiorgan failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the resuscitation protocol for GI perforation?

A

Correct fluid + electrolytes
IV Abx (with anaerobic cover): cefuroxime + metronidazole
Nil by mouth + NG tube inserted

17
Q

Describe management of gastroduodenal perforation

A

Laparotomy
Peritoneal lavage
Perforation is closed with an omental patch
Gastric ulcers are biopsied: malignancy
Helicobacter pylori eradication if test positive

18
Q

List 4 complications of oesophageal perforation

A

Mediastinitis
Shock
Overwhelming sepsis
Death

19
Q

What is the prognosis of gastroduodenal perforations?

A

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

20
Q

What may be seen on CXR in GI perforation?

A

Air under the diaphragm

21
Q

What may be seen on AXR in GI perforation?

A

Rigler’s sign: both sides of bowel wall can be seen due to free intra-abdominal air acting as an additional contrast
Psoas sign: loss of the sharp delineation of the psoas muscle border, secondary to fluid in the retroperitoneum

22
Q

What investigation may be performed for suspected oesophageal perforation?

A

Gastrograffin Swallow

23
Q

Describe the management of large bowel perforations

A

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

24
Q

Describe the management of oesophageal perforations

A

Pleural lavage

Repair of ruptured oesophagus

25
Q

Give 2 complications of large and small bowel perforation

A

Peritonitis

Septicaemia