Perforated Viscus

Question 1

What is the presenting complaint in patients with perforated viscous?

Answer 1

Severe abdominal pain
Sudden, followed by worsening condition
- will frequently relate a prior abdominal pain history that is less severe due to the underlying cause of the perforation

Question 2

What imaging do you need?

Answer 2

Upright CXR to show air under the diaphragm.

However, you cannot rule in or out for sure based on an upright CXR

Question 3

What is the best imaging for seeing free air?

Answer 3

CT Abdomen/Pelvis. It can detect even minute amounts of free air.
- Other advantages: can determine other causes of abdominal pain.

Question 4

What are the 3 main treatment things you have to do for a patient with a perforated viscus?

Answer 4

Resuscitation
Early antibiotics
Early surgical consultation

Question 5

What fluids do you need?

Answer 5

TWO large bore IVs and start IV fluid resuscitation to help with normalization of vital signs and to restore adequate tissue perfusion.

Question 6

What are common empirical antibiotic choices for the abdomen?

Answer 6

Common empiric regimens for abdominal sources include: ciprofloxacin + metronidazole, piperacillin/tazobactam, or imipenem.