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perforated-viscous

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