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perforated_viscus

perforated viscus

introduction

  • this refers to perforation of the gastro-intestinal tract
    • free perforation occurs when GIT contents spill freely into the abdominal cavity, causing diffuse peritonitis
    • contained perforation occurs when a full-thickness hole is created but free spillage is prevented because contiguous organs wall off the area (eg. a penetrating DU walled off by the pancreas)
  • the patient with a perforated abdominal viscus generally becomes rapidly unwell and presents with severe pain and a rigid abdomen.
  • this is a surgical emergency requiring immediate fluid resuscitation and transfer to theatre ASAP once diagnosis is made
  • diagnosis in free perforations is usually supported by the finding of free gas under the diaphragm on an erect CXR
    • not to be confused with normal gastric or hiatus hernia air bubble, nor with lucencies from adipose tissue, nor the normal post-laparotomy/laparoscopy free gas

aetiology

clinical features

DDx

ED Mx of suspected perforated viscus

  • nil orally
  • fluid balance chart
  • iv access
  • bloods for FBE, U&E, glucose, LFTs, lipase, (HCG if possibly pregnant), VBG/serum lactate
  • commence iv fluid resuscitation
  • notify surgical team ASAP for emergent theatre
  • if diagnosis is not clear consider:
    • erect CXR +/- erect/supine AXR
    • CT abdo without oral contrast as time will not usually permit oral contrast to be administered
  • iv antibiotics as per hospital guidelines
perforated_viscus.txt · Last modified: 2018/01/09 01:18 by gary1