GI perforation

• What is a GI perforation?

  Hole in the wall of any part of GIT
• What are some common causes of GI perforation?

  Oesophageal/gastric malignancies

  Appendicitis

  Diverticulitis

  Peptic ulcer

  Crohn's disease

  Trauma

  Bowel cancer

  Bowel obstruction

  Iatrogenic causes
• What happens when there is a GI perforation?

  Contents from within GIT leak into sterile abdominal cavity -> peritonitis
• What are the signs & symptoms of GI perforation?

  Depends on location & severity

  Severe abdo pain

  Nausea & vomiting

  Fatigue

  Peritonism

  Hypotension

  Tachycardia

  Tachypnoea

  Fever
• What are the DDx of GI perforation?

  Non-specific abdo pain

  Spontaneous bacterial peritonitis

  Appendicitis

  Pancreatitis
• What are the Inx for GI perforation?

  Obs

  Full Hx & examination

  Pregnancy test

  Bloods (ABG/VBG, FBC, CRP, LFTs, U&Es, coag, group & save, ? cultures)

  CT with contract

  Erect CXR
• What is the management of GI perforation?

  Nil by mouth

  Urgent surgical review

  Consider NG tube

  IV broad spec Abx

  IV fluids

  Analgesia

  Anti-emetics

  Surgery

  • laparotomy + thorough washout
  • identify & repairing perforation defect