Gastro: Boerhaave Syndrome Brief: Free MSRA Podcast

⚕️FREE MSRA PODCAST –Boerhaave Syndrome🎧 A clear, high-yield breakdown of this rare life-threatening spontaneousoesophageal rupture – perfect for examprep and real-life clinical scenarios. 🧠 Key Learning Points📌 Definition• Spontaneous,full-thickness rupture of the oesophageal wall, usually after a sudden spike inintra-oesophageal pressure (classically forceful vomiting).📌 Causes & Risk Factors• Severeretching/vomiting (most common)• Excess alcoholintake• Over-eating orbinge-eating episodes• Iatrogenic injury(endoscopy, NG insertion)• Previousoesophageal surgery• Hiatal hernia• Eating disorderswith purging behaviourMnemonic – A H E A PA Alcohol abuse HHiatal hernia E Eating-disorder purging A (Endoscopic) procedures P Previous surgery📌 Pathophysiology• Sudden pressuresurge without adequate UOS relaxation → linear, left-posterolateral tear indistal third of oesophagus• Leakage of air,saliva, gastric contents into mediastinum → chemical mediastinitis → rapidlyprogressive sepsis & shock📌 Symptoms• Sudden, severe“tearing” chest or epigastric pain radiating to back/shoulder• Subcutaneousemphysema/neck crepitus• Vomiting ± haematemesis• Dyspnoea,tachycardia, hypotension, fever (sepsis)Mnemonic – 3 S’sSudden Severe pain – Subcutaneous emphysema – Sepsissigns📌 Differential Diagnosis• Acute MI• Pulmonary embolism• Aortic dissection• Mallory-Weiss tear• Bleedingoesophageal varices• Spontaneouspneumothorax📌 Diagnosis• Chest X-ray: pneumomediastinum, left pleuraleffusion, pneumothorax (may be normal early)• CT thorax with oral water-soluble contrast (goldstandard): localises leak & contamination• Water-solublecontrast oesophagography if CT equivocal• Routine bloods:FBC, U&E, CRP, lactate; group & save/cross-matchQuick tip: Think “vomit + sudden chest pain = CT NOW”.📌 Management• Immediate surgical referral – this is a time-criticalemergency• Broad-spectrum IVantibiotics ± antifungal cover (e.g. piperacillin-tazobactam)• Large-bore IVaccess, fluid resuscitation, analgesia, oxygen• Urgent operativerepair with pleural/mediastinal wash-out ± reinforced patch• ICU post-op care,early enteral/parenteral nutrition• UK/NICEpriorities: sepsis bundle within 1 h, early senior surgical decision-making,regular NEWS2 scoring📌 Complications• Mediastinitis& septic shock• Respiratoryfailure/ARDS• Empyema or pleuraleffusion• Multiorgan failure• Death (mortality> 50 % if treatment delayed > 24 h)📌 PrognosisEarly recognitionand repair within 24 hours carries a survival of 80–90 %. Delayed diagnosismarkedly worsens outcomes. Alcohol misuse and comorbid malnutrition furtherincrease mortality. 📎 More MSRA Resources for Boerhaave Syndrome📝Revision Notes: https://www.passthemsra.com/topic/boerhaave-syndrome-revision-notes/🧠Flashcards: https://www.passthemsra.com/topic/boerhaave-syndrome-flashcards/💬Accordion Q&ANotes: https://www.passthemsra.com/topic/boerhaave-syndrome-accordion-qa-notes/🚀Rapid Quiz: https://www.passthemsra.com/topic/boerhaave-syndrome-rapid-quiz/🎓Full Course: https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ #MSRA #MSRARevision#MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQ&ANotes#MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision#MSRARevisionWebsite #BoerhaaveSyndrome