Boerhaave syndrome Accordion Q&A Notes
Boerhaave Syndrome Active Recall Accordion Q&A Revision Notes
(Question and Answer Active Recall Accordion Notes – please click the arrow to display the answer to the revision questions)
Definition of Boerhaave Syndrome
• Boerhaave Syndrome is a rare life-threatening condition characterized by a full-thickness rupture of the oesophagus
• Typically caused by forceful vomiting or retching
Aetiology of Boerhaave Syndrome
• Sudden increase in intraluminal oesophageal pressure due to forceful vomiting
• Contributing factors: alcohol abuse, overeating, medical procedures
Risk Factors for Boerhaave Syndrome
• Alcohol abuse
• Eating disorders
• Hiatal hernia
• Previous oesophageal surgery
• Oesophageal-involved medical procedures (e.g., endoscopy)
Pathophysiology of Boerhaave Syndrome
• Sudden rise in intraesophageal pressure during vomiting
• Rupture of the weakened oesophageal wall, usually in the left posterolateral aspect of the distal oesophagus
Differential Diagnosis of Boerhaave Syndrome
• Myocardial infarction
• Pulmonary embolism
• Oesophageal varices
• Mallory-Weiss Syndrome
Epidemiology of Boerhaave Syndrome (UK)
• Prevalence is not well-documented
• It’s rare but can occur across all age groups
Clinical Presentation of Boerhaave Syndrome
Symptoms:
• Sudden severe chest pain
• “Tearing” or “ripping” pain
• Mediastinitis symptoms (fever, rapid heart rate)
Signs:
• Subcutaneous emphysema (air under the skin)
• Signs of sepsis
Investigations for Boerhaave Syndrome
• Chest X-ray for signs of pneumomediastinum or pneumothorax
• CT scan, oesophagography, and oesophagoscopy for diagnosis and assessment
Management of Boerhaave Syndrome (UK)
• Medical emergency necessitating immediate surgical intervention
• Primary repair of oesophageal rupture using muscle/tissue flaps
• Antibiotics administration
• Supportive care to prevent and treat infections
Prognosis and Complications of Boerhaave Syndrome
• Prognosis: Linked to prompt diagnosis and treatment; delayed diagnosis is associated with high mortality
• Complications: Mediastinitis, sepsis, respiratory failure, surgery-related issues
• Early intervention improves prognosis and reduces the risk of complications