Perforation.pptx

For 2nd year B.Sc Nursing students

1. PERFORATION Presented By: Mr . Nandish. S Asso . Professor Mandya Institute of Nursing Sciences

2. Definition : It is 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%).

3. 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

4. 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

5. 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 P hrenic Nerve Nausea & Vomiting Collapse / Fainting Extremely tender & rigid abdomen Tachycardia & Hypotension

6. Diagnostic studies : History collection & Physical Examination Abdominal X – Ray (When patient is in upright position) CT Scan MRI CBC (WBC) Ultrasound (Children)

7. Complications : Sepsis Bleeding Anastamotic leakage Hernia Thrmboembolism Respiratory failure

8. Management : The problem become 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

9. Conservative treatment : Bowel rest Frequent abdominal examinations. Intravenous therapy Antibiotics Nasogastric aspiration Radiology guided drainage of collected fluid.

10. Nursing : Explain about 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.

11. THANK YOU