Perforated “Viscous” (aka. GI tract; bowels):
Author:
Yan Yu
Reviewers:
Michael Blomfield, Tony Gu, Dean Percy, Danny Guo Maitreyi Ramran* * MD at initial time of publication
Chest X-Ray (CXR)
Pathogenesis and Clinical Findings
Diverticulitis
Crohn’s disease Peptic ulcer (H. pylori
infection, NSAID use, ICU stress, etc)
Appendicitis
Malignant neoplasm
Irritates visceral peritoneum, stimulates autonomic nerves
Severe inflammation causes destruction of GI tract mucosa
Over time, Perforation of the GI tract wall
Bowel contents (air, fluids) released into peritoneal cavity
Massive peritoneal inflammation
Diagnostic investigations if a GI perforation is suspected
Dull diffuse abdominal pain
Severe, Sharp abdominal pain with peritoneal signs
Abdominal X-ray
Irritation of parietal peritoneum, stimulates somatic nerves
• Abdominal X-ray
• Intra-peritoneal air will coat the GI tract surfaces, giving them a faint white outline
under X-ray
• Chest X-ray of upright patient (Diagnostic)
• Intra-peritoneal air will rise above the peritoneal fluid when pt is upright, accumulating under the right hemi-diaphragm.
• Note: air under left hemi-diaphragm = normal gastric bubble
• CT? Most patients with suspected GI perforation will get a CT scan, but this is not the diagnostic gold standard (and access to CT can be limited, especially in rural settings)
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Re-Published June 30, 2019 on www.thecalgaryguide.com