Perforation.pptx

Perforation.pptx

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  PERFORATION Presented By: Mr. Nandish.S Asso. Professor Mandya Institute of Nursing Sciences
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  Definition :  Itis the erosion of ulcer through gastric serosa into the peritoneal cavity.  A hole that develops through the wall of GI Tract.  It is commonly seen in large penetrating duodenal ulcers.  They are most commonly located on the lesser curvature of stomach.  Mortality rate associated with perforation are very high (10-25%).
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  Etiology:  Duodenal ulcers: size of perforation is directly proportional to length (duration) of ulcer.  Trauma  Appendicitis  Cholecystitis  Diverticulitis  Inflammatory Bowel Disease (IBD), Crohn’s disease & Ulcerative colitis  Ascariasis  Superior Mesenteric artery syndrome
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  Risk Factors : Knife or Gun shot wound  Accidental swallowing of corrosive chemicals (Magnets, Battery)  Bowel Impaction  Forceful vomiting  Procedures like colonoscopy  Stomach or colorectal cancer
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  Clinical Manifestations : Sudden, severe pain (pain in right of midline indicating duodenal ulcer & burning pain epigastric region suggests gastric ulcer).  Shoulder pain due to irritation of Phrenic Nerve  Nausea & Vomiting  Collapse / Fainting  Extremely tender & rigid abdomen  Tachycardia & Hypotension
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  Diagnostic studies : -History collection & Physical Examination - Abdominal X – Ray (When patient is in upright position) - CT Scan - MRI - CBC (WBC) - Ultrasound (Children)
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  Complications : o Sepsis oBleeding o Anastamotic leakage o Hernia o Thrmboembolism o Respiratory failure
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  Management : The problembecome severe within 6 to 12 hours, treatment should be given as quickly as possible. Surgical : - Laproscopic Exploration. - Resection or Repair of perforated site. - Closure of perforation with peritoneal wash - Omental Patch - Graham patch
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  Conservative treatment : •Bowel rest • Frequent abdominal examinations. • Intravenous therapy • Antibiotics • Nasogastric aspiration • Radiology guided drainage of collected fluid.
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  Nursing :  Explainabout the post operative outcomes  Performing surgical wound dressing  Guiding the family members about diet therapy  Maintenance of fluid & electrolyte balance  Pain management  Instruct about follow up care.
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  THANK YOU