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
Gastric Perforation best initial test is
an upright chest x-ray which shows free air under the diaphragm.
Gastric Perforation most accurate test
CT scan.
Gastric Perforation Tx summary
Make patient NPO
Place NG tube
Medical management
Emergent surgery
Gastric Perforation Tx detailed. Why NPO
Prevents further extrusion of gastric contents into peritoneal cavity
Gastric Perforation Tx detailed. Why Place NG tube
Suctions gastric contents
Mitigates risk from newly formed acid
Gastric Perforation Tx detailed. What Medical management?
Broad-spectrum antibiotics to combat infection
IV fluids in preparation for surgery
Gastric Perforation Tx detailed. Why Emergent surgery
Exploratory laparotomy and repair of the perforation
If the RLQ pain presents in a female patient of childbearing age,
___________must be considered. Get a_____
ectopic pregnancy, cysts, and torsion
beta-HCG and pelvic sonogram. Remember, avoid radiation imaging tests (CT and x-rays) in a patient who may be pregnant. If the sonogram shows an ectopic pregnancy, emergent surgery must be performed.
______ has an acute onset of severe abdominal pain that is most likely located in the lower left quadrant.
Acute diverticulitis
first bout of diverticulitis are treated______
medically if there are no complications warranting surgery.
recurrent diverticulitis will need
resection of the affected loop of bowel.
The most common complication after diverticulitis is
abscess formation.
Diverticulosis can occur anywhere in the colon, but in elderly patients, the _______ is most involved, making it the most likely location for inflammation.
sigmoid region
Barium enema and colonoscopy are ______ in diverticulitis due to an increased incidence of perforation
contraindicated
