Visceral Perforation Flashcards
Shoulder tip pain following a visceral perforation suggests irritation of where?
Diaphragm
What artery provides the blood supply to the ascending colon?
Superior mesenteric artery
Which is not radiographic evidence of pnuemoperitoneum?
a) Air under diaphragm
b) Rigler’s sign
c) Psoas sign
d) Murphy’s sign
d) Murphy’s sign
Murphy’s sign is associated with acute cholecystitis
What is visceral perforation
Defined as a hole through the wall of the GI tract
Also known as GI perforation
At what point in the GI tract does a visceral perforation occur?
May occur at any anatomical location from the upper oesophagus to the anorectal junction
What is the most common cause of visceral perforation in high income countries
Diverticulitis (inflammation of the diverticula)
Name some of the causes of visceral perforation
Diverticulitis [most common in high income countries]
Peptic ulcer disease
GI malignancy e.g. gastric or colorectal
Iatrogenic e.g. during surgery
Trauma e.g. ingestion of a foreign body
Appendicitis
Meckel’s Diverticulitis
Severe colitis such as Crohn’s Disease
Oesophageal perforation secondary to vomiting (Boerhaave’s syndrome)
What are some of the clinical features of visceral perforation
Sudden onset sharp pain
Systemically unwell – associated malaise, vomiting and lethargy
Features of peritonism
Name the two features of peritonism
Rigid abdomen and involuntary guarding
Rebound tenderness (pressing on the abdomen elicits less pain than releasing the hand)
Define Involuntary guarding
Refers to the involuntary tensing of the abdominal wall muscles in response to pressure on the abdomen
What is the gold standard investigation for visceral perforation
CT scan
CT scan is the gold standard investigaton for visceral perforation.
What are the CT scan features for visceral perforation?
The presence of free air and suggesting a location of the perforation (as well as a possible underlying cause)
CT scan is the gold standard investigaton for visceral perforation.
What are the two imaging modalities that can be useful but less specific than CT
Erect chest radiograph (eCXR) and abdominal radiograph (AXR)
What is a good blood test to remember for any bleeding
G&S
What is the difference between a group and save and a crossmatch?
Group and Save: Sample processing. Consists of a blood group and an antibody screen to determine the patients group and whether or not they have atypical red cell antibodies in their blood.
Crossmatch: When the laboratory actually provides red cells products for the patient. It is not possible for the laboratory to provide crossmatched blood without having processed a group and save sample first.
Pnuemoperitoneum is the key radiographic feature of visceral perforation.
What are the 3 radiological signs of pneumoperitoneum
Free air under the diaphragm (double bubble)
Rigler’s sign (double wall sign; both sides of the bowel visible)
Psoas sign (loss of the sharp delineation of the psoas muscle border)
(1) Define the double bubble radiological sign and (2) in which condition is it present in
(1) Free air under the diaphragm
(2) Visceral perforation
(1) Define the Rigler’s sign and (2) in which condition is it present in
(1) Radiological features - double wall sign; both sides of the bowel visible
(2) Visceral perforation
