GI Perforations and more Flashcards
Esophageal Perforation patho
due to the rapid increase in intraesophageal pressure combined with negative intrathoracic pressure caused by vomiting.
Esophageal Perforation cxfx
- Severe and acute onset of excruciating retrosternal chest pain
- Odynophagia
- Positive Hamman sign, a crunching heard upon palpation of the thorax due to subcutaneous emphysema
- Pain that can radiate to the left shoulder
Boerhaave syndrome Patho
full thickness tear secondary to extreme retching and vomiting. It is most commonly tested in the setting of an alcoholic
The most common location of the Boerhaave syndrome is at
the left posterolateral aspect of the distal esophagus.
Mallory-Weiss syndrome is a ______tear and is also due to vomiting. It is not a_____. The most common location is at the__________.
mucosal
perforation
gastroesophageal junction
The most common cause of
esophageal perforation is
iatrogenic.
The most common
procedure that causes an
esophageal perforation is upper endoscopy
Boerhaave syndrome
carries___ mortality,
25%
even with surgery.
Esophageal Perforation “Boerhaave”/Mallory-Weiss syndrome most accurate test is
esophagram using diatrizoate meglumine and diatrizoate sodium solution (Gastrografin);
it will show leakage of contrast outside of the esophagus. Barium cannot be used because it is caustic to the tissues.
Esophageal Perforation tx
Surgical exploration with debridement of the mediastinum and closure of the perforation is an absolute emergency.
Esophageal Perforation complication
Mediastinitis is a complication that carries
a very high mortality rate.
Mucosal tear: “ Mallory-
Weiss syndrome” Tx
Supportive
Cauterization if necessary
The fact that there is a full bottle implies the patient is
noncompliant with his medication.
Gastric Perforation. Less common , but common, etiologies
burns, head injury, trauma, and cancer.
The gastric acid has also been shown to cause pancreatitis if the ulcer is in the _________
posterior part of the stomach.
The acid leaks out the back of the stomach and literally fries the pancreas.
Gastric Perforation CxFx
Acute, progressive worsening abdominal pain that radiates to the right shoulder due to acid irritation of the phrenic nerve
Likely signs of peritonitis by the time the patient comes to the ED, including:
Guarding
Rebound tenderness
Abdominal rigidity
