 Welcome to the emergency medicine video. This video is about perforated viscis, who first discuss the causes and presentations of the patients with the perforated viscis. The definition of perforated viscis means the perforation of the GI tract, usually from the stomach all the way down to the end. This is a deadly diagnosis since the bacteria from the gut can quickly spread and produce a sepsis. We'll first talk about the presentation of the patient in a general sense, and then we'll move on to each specific cause. In general, the presentation will be abrupt and severe pain. In terms of the vital signs, patients can be tachycardic, and depending on their course of illness might be hypotensive. They might have a fever. On examination, the patients will be in distress. They may have a board-like rigidity to their abdomen and will not want to move. They will have significant tenderness with superficial palpation. There will be involuntary guarding and significant rebound tenderness. These are sick patients. Based on the specific cause of the perforated viscis, the patient's presentation might include different things as well. Let's look at the different causes of perforated viscis. The first cause is a perforated ulcer. The next cause, from local inflammation such as appendicitis, or diverticulitis, pose instrumentation such as colonoscopy, or after surgery in the anastomosis site. Lastly, it can also be from bowel obstruction. Let's look at the history and the presentation for each of these specific causes. For patients with peptic ulcer disease, what kind of questions on history do we want to know about? Well, you want to know about risk factors such as smoking, alcohol, and use of medications such as NSAIDs. They might describe dyspepsia or pain after eating. They might present as hematemesis, malina, or even hemerochesia for a briskly bleeding ulcer. In addition to the general appearance we talked about before, patients with a perforated peptic ulcer might have their pain struts in the upper abdomen first. What about the patients with local inflammation? What kind of history and presentation might they have? In patients with appendicitis leading to a perforation, the classic signs would be parambolicopane that radiates to the right lower quadrant. There might be fever, vomiting, and anorexia. In patients with diverticulitis, their initial presentation might start off in the left lower quadrant. With both of these local inflammation, the perforation might be contained in that area, or it may become generalized. That will affect how the patient present and how sick they look. For the patient who is post-op or post-colonoscopy, for these patients you really want to find out exactly what procedure is done. Lastly, what about patients who have an obstruction leading to a perforation? What history should we obtain? We want to find out if there has been any surgeries in the past, any bio-obstructions in the past. On presentation, the patients often will have lots of vomiting, abdominal distention, and crampy abdominal pain. After a perforation has occurred after an obstruction, then the presentation will become more of the patient with sepsis picture, with generalized guarding and looking ill. In summary, in this section we talk about the general and specific presentation of patients who might have a perforated viscous. In the next part, we will discuss the investigations and treatment. Thank you for watching.