Boerhaave syndrome history and symptoms: Difference between revisions

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===History===
===History===
* Obtaining history gives important information in making a diagnosis of BHS.  
* Obtaining history gives important information in making a diagnosis of BHS.  
* It provides an insight into the cause, precipitating factors, and associated [[Comorbidities|comorbid]] conditions.  
* It provides insight into the cause, precipitating factors, and associated [[Comorbidities|comorbid]] conditions.  
* A complete history will help determine the correct [[therapy]] and determining the [[prognosis]].  
* A complete history will help determine the correct [[therapy]] and determining the [[prognosis]].  
* The areas of focus should be on onset, duration, and progression of symptoms such as
* The areas of focus should be on onset, duration, and progression of symptoms such as


===Symptoms===
===Symptoms===
*The clinical manifestations of [[Boerhaave syndrome]] depend on the  
*The clinical manifestations of [[Boerhaave syndrome]] depend on the:
**Location of the perforation ([[cervical]], [[intrathoracic]], or intra-abdominal),  
**Location of the perforation ([[cervical]], [[intrathoracic]], or intra-abdominal),  
**The time since the injury  
**The time since the injury  
**The degree of leakage
**The degree of leakage
*[[Boerhaave syndrome]] often presents with excruciating [[retrosternal]] [[chest pain]] due to an [[intrathoracic]] [[Boerhaave syndrome|esophageal perforation.]]   
*[[Boerhaave syndrome]] often presents with excruciating [[retrosternal]] [[chest pain]] due to an [[intrathoracic]] [[Boerhaave syndrome|esophageal perforation.]]   
*[[Boerhaave syndrome]] classically associated with a history of severe [[retching]] and [[vomiting]], however, 25 to 45 percent of patients have no history of [[vomiting]].
*[[Boerhaave syndrome]] is classically associated with a history of severe [[retching]] and [[vomiting]], however, 25 to 45 percent of patients have no history of [[vomiting]].
*Soon after the [[perforation]], patients can have  
*Soon after the [[perforation]], patients can have:
**[[Odynophagia]]
**[[Odynophagia]]
**[[Dyspnea]]
**[[Dyspnea]]
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**[[Cyanosis]], and [[hypotension]] on physical examination.  
**[[Cyanosis]], and [[hypotension]] on physical examination.  
**A [[pleural effusion]] may also occur.
**A [[pleural effusion]] may also occur.
*Patients with [[cervical]] [[perforations]] can present with  
*Patients with [[cervical]] [[perforations]] can present with:
**Neck pain
**Neck pain
**[[Dysphagia]]  
**[[Dysphagia]]  
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**[[Subcutaneous emphysema]]
**[[Subcutaneous emphysema]]
*It may also be audibly recognized as [[Hamman's sign]].
*It may also be audibly recognized as [[Hamman's sign]].
*'''[[Hamman's sign]]''' is a crunching, rasping sound, synchronous with the heartbeat, heard over the [[precordium]] in spontaneous [[Mediastinum|mediastinal]] [[emphysema]] produced by the heart beating against air-filled [[tissues]]
*'''[[Hamman's sign]]''' is a crunching, rasping sound, synchronous with the heartbeat, heard over the [[precordium]] in spontaneous [[Mediastinum|mediastinal]] [[emphysema]] produced by the heart beating against air-filled [[tissues]].


==References==
==References==
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Needs English Review]]
[[Category:Up-To-Date]]

Latest revision as of 14:36, 26 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2], Ajay Gade MD[3]], Feham Tariq, MD [4]

Overview

The clinical manifestations of Boerhaave syndrome (BHS) depend on the location of the perforation. Boerhaave syndrome often presents with excruciating retrosternal chest pain due to an intrathoracic esophageal perforation. Boerhaave syndrome is classically associated with a history of severe retching and vomiting. However, 25 to 45 percent of patients have no history of vomiting.

History and Symptoms

The history and symptoms are as follows:[1][2][3][4][5]

History

  • Obtaining history gives important information in making a diagnosis of BHS.
  • It provides insight into the cause, precipitating factors, and associated comorbid conditions.
  • A complete history will help determine the correct therapy and determining the prognosis.
  • The areas of focus should be on onset, duration, and progression of symptoms such as

Symptoms

References

  1. McGovern M, Egerton MJ (1991). "Spontaneous perforation of the cervical oesophagus". Med. J. Aust. 154 (4): 277–8. PMID 1994204.
  2. Wilson RF, Sarver EJ, Arbulu A, Sukhnandan R (1971). "Spontaneous perforation of the esophagus". Ann. Thorac. Surg. 12 (3): 291–6. PMID 5112482.
  3. Woo KM, Schneider JI (2009). "High-risk chief complaints I: chest pain--the big three". Emerg. Med. Clin. North Am. 27 (4): 685–712, x. doi:10.1016/j.emc.2009.07.007. PMID 19932401. Unknown parameter |month= ignored (help)
  4. Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH (1989). "Spontaneous rupture of the esophagus: a 30-year experience". Ann. Thorac. Surg. 47 (5): 689–92. PMID 2730190.
  5. Brauer RB, Liebermann-Meffert D, Stein HJ, Bartels H, Siewert JR (1997). "Boerhaave's syndrome: analysis of the literature and report of 18 new cases". Dis. Esophagus. 10 (1): 64–8. PMID 9079278.

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