Perforated Viscus: Management

by Sharon Bord, MD

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    00:01 So what do we do for these patients? So we found out that our patient does have a perforated viscus and we wanna move on and think about what the next steps are.

    00:09 So first and foremost in the Emergency Department, ABC’s.

    00:13 So think about the airway and the breathing.

    00:15 Think about fluid and volume resuscitation.

    00:19 Your patient will likely need two large bore IV’s.

    00:22 So that’s something larger than an 18 gauge IV.

    00:25 Either an 18, a 16, or a 14 gauge IV.

    00:29 You wanna think about transfusing blood product or the very least, getting blood products ready.

    00:34 So does your patient need a red blood cell transfusion? Are they on anticoagulants and do they need FFP? So sending coagulation studies and a type and cross will put you in a good place.

    00:46 You wanna give antibiotics.

    00:48 You wanna cover the gut flora.

    00:50 So you wanna cover anaerobes.

    00:52 You wanna cover enteric pathogens.

    00:54 And you want those to be broad spectrum.

    00:56 Your patient is super sick.

    00:58 You wanna make sure that you’re covering all the possible bacteria that could be floating around in their abdominal cavity.

    01:06 And then you wanna involve surgery.

    01:07 Right when you suspect this diagnosis, you wanna call your surgical consult.

    01:12 You wanna get them on board, you wanna tell them what your concerns are.

    01:16 It’s possible that interventional radiology could play a role here but for the most part, your patient may in fact need surgical intervention.

    01:25 So the conclusions here.

    01:28 Perforated viscus is a very serious condition.

    01:30 It has a very high mortality.

    01:32 Maintain a high suspicion for this diagnosis.

    01:36 This is not something that you wanna miss.

    01:38 The most common causes of perforated viscus are peptic ulcer disease and diverticulitis.

    01:44 And you wanna be sure you’re asking your patient about if they’ve ever had any prior abdominal pain that would support a diagnosis of peptic ulcers or prior symptoms that would support that.

    01:54 Same thing with supporting diagnosis of diverticulitis.

    01:58 The classic history here is severe and sudden onset of pain.

    02:01 Oftentimes, this will not be a subtle presentation but be wary of the elderly and immunocompromised because they may present in very unusual ways.

    02:10 Early surgical consultation is a key management step.

    02:14 So definitely be sure to get your surgeon onboard early if you’re worried about a perforated viscus.

    About the Lecture

    The lecture Perforated Viscus: Management by Sharon Bord, MD is from the course Abdominal and Genitourinary Emergencies.

    Included Quiz Questions

    1. Peptic ulcer disease and diverticulitis
    2. Peptic ulcer disease and diverticulosis
    3. Peptic ulcer disease and ulcerative colitis
    4. Crohn's disease and ulcerative colitis
    5. Gastritis and diverticulosis
    1. A perforated viscus in an elderly or immunocompromised patient is easier to diagnose than one occurring in a younger and immunocompetent patient.
    2. It has a high mortality rate.
    3. It is important to ask about prior abdominal pain and other associated symptoms.
    4. The classic presentation of a perforated viscus is severe and sudden onset of pain.
    5. Early surgical consultation is a key management step.

    Author of lecture Perforated Viscus: Management

     Sharon Bord, MD

    Sharon Bord, MD

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