GI perforation

Question 1

Potential causes of GI perf?

Answer 1

Inflammation, infection, malignancy, trauma, bowel ischaemia or obstruction, peptic ulcer disease

Question 2

What is the presentation of GI perf?

Answer 2

Sudden onset, acute abdomen, nausea, vomiting, chills, fever, shoulder tip pain, abdominal bloating.
o/e - distended abdomen, decreased or absent bowel sounds, guarding and rebound tenderness

Question 3

Investigations for suspected GI perf?

Answer 3

Bloods - LFTs, U&Es, FBC, CRP, lactate
Erect chest X ray
CTAP

Question 4

Management of GI perf?

Answer 4

A-E exam
Two large grey cannulas
IV fluid resus and antibiotics

Question 5

Features and investigations of perforated peptic ulcer?

Answer 5

Symptoms - sudden onset of epigastric pain (later becomes generalised) and syncope.
Ix - Erect chest x ray

Question 6

Features and investigations of boerhaave’s syndrome

Answer 6

Spontaneous rupture of oesophagus (severe vomiting or iatrogenic)
Presentation - Severe sudden onset of chest pain, subcutaneous emphysema
Investigations - CT with contrast swallow

Question 7

Treatment and complications of boerhaave’s syndrome

Answer 7

Initial - A-E exam, NBM, Large IV cannulas, fluid resus and abx for mediastinitis
Treatment is tharacotomy and lavage if onset less than 12hr ago. If over 12hr then insertion of T tube to create fistula between oesophagus and skin.
Complications - severe sepsis secondary to mediastinitis