Perforated viscus

Question 1

What is the definition of perforated viscus?

Answer 1

An organ with an abnormal opening

Question 2

What is the mortality rate of perforated viscus?

Answer 2

Mortality around 30-50%

Question 3

What is the pathology of perforated viscus?

Answer 3

• Leakage = peritonitis

Question 4

What are the risk factors/aetiology of perforated viscus?

Answer 4

• Immunocompromised
• Co-morbidities
• Appendicitis
• Diverticulitis
• Stomach ulcer – inc. NSAIDs
• Gallstones/gallbladder infection
• Inflammatory bowel disease
• Cancer of the GI tract
• Trauma
• Bacteria/bile/stomach acid/partially digested food/stool in the abdominal cavity
• Smoking
• Alcohol

Question 5

What are the signs and symptoms of perforated viscus?

Answer 5

• Sudden and severe abdominal pain
• Rigidity, involuntary guarding and diffuse rebound tenderness
• Nausea/vomiting
• Abdominal distention
• ↓ urine, stools and gas
• Hypotensive
• Tachypneic
• Tachycardic
• Febrile

Question 6

What diseases present similarly to perforated viscus?

Answer 6

• AAA

* Haemoperitoneum

Question 7

What are the investigations carried out for a suspected perforated viscus?

Answer 7

• X-ray
• CT
• US
• FBC
• Cross match
• Coagulation screen
• Blood gas
• Lactic acid
• Kidney bloods
• Liver bloods
• Lipase/amylase
• Urinalysis

Question 8

What are the surgical treatments for perforated viscus?

Answer 8

• Laparotomy with complete exploration of the GI tract
• Colostomy/ileostomy
• Decontamination of spilled contents with repair of perforated site
• Endoscopic clips
• Percutaneous drainage of abscesses

Question 9

What are the pharmacological treatments for perforated viscus?

Answer 9

• Antibiotics
• Fluids
• Oxygen

Question 10

What are the non pharmacological treatments for perforated viscus?

Answer 10

Non as MEDICAL EMERGENCY