Jpola3399

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If you have any questions, please don't hesitate to contact me on my talk page. Ian (Wiki Ed) (talk) 16:52, 26 October 2023 (UTC)

GI Perf. Article

Think you deleted the chronic opioid part - could you add this back - it is very well documented and overlooked in a clinical setting as a cause.

Lots of current patients in my practice.

BeingObjective (talk) 14:15, 3 November 2023 (UTC)

My apologies, I had missed your recent edit when I made my changes. Added back! Jpola3399 (talk) 14:27, 3 November 2023 (UTC)

With respect - I think the injury section was all about originally trauma linked - if I recall the article was split into traumatic and disease state causes.

It now reads as though they are all physical/traumatic causes - even the ischemia bit - do you feel your changes added value - I think if you read your edits - you might see this - best regards. BeingObjective (talk) 14:38, 3 November 2023 (UTC)

The article initially listed all causes together in one main paragraph (both disease states and trauma) as one long list. My goal was to split causes into categories based on mechanism of injury for better readability and understanding. Medical textbooks and reference articles categorize perforation in this way. I do believe these changes add value, but you are welcome to build off of this or recategorize as you see fit. Jpola3399 (talk) 14:53, 3 November 2023 (UTC)

Understood - I think it is the title about INJURY - I think one could argue trauma or diseases cause injury - perhaps a mod. to the title section - I moved the section on opioids - it is a personal practice concern of mine - I might be overly picky - cheers. BeingObjective (talk) 14:58, 3 November 2023 (UTC)

I really did not review this article all that fully nor in the context of the larger GI perforation topic - and really I think the original author was really talking about the colon - hence Bowel Rupture.

If one wants to make this about the GI tract - mouth to anus - I think the whole opening paragraph is incorrect. In the talk section there are comments from another physician and I think the same discussion is made.

I'll leave it with you.

Dr. BeingObjective (talk) 18:43, 15 November 2023 (UTC)

I believe it was the other way around - the article always encompassed perforation along the entire GI tract. If you look at previous edits, esophageal and gastric ruptures were always included in all sections. The previous discussion was whether other or not you can use “bowel perforation” as a synonym for GI perf because the article encompasses more anatomy than that. Jpola3399 (talk) 18:57, 15 November 2023 (UTC)

Understood - regardless, do you think it makes sense now - as written? BeingObjective (talk) 21:28, 15 November 2023 (UTC)

Which part, the article topic as a whole or the lead? The first sentence of the lead could make sense depending on context. However, this article discusses perforation along the entire GI tract and now the first sentence of the lead suggests otherwise which is not in accordance with the rest of the article (i.e gastric ulcers, esophageal rupture).

Do I think it makes sense for the article topic to include the entire GI tract as opposed to just lower? It could go either way, but I don't think it's necessary to split the concept into two separate entities. The pathophysiology (full-thickness wall discontinuity, also referred to as "injury" - which is not necessarily traumatic by the nature of the word) is the same regardless of whether the perf occurs in the upper or lower GI tract. The mechanisms (malignancy, ulcers, trauma), complications, and management (antibiotics, fluids, emergency surgery) are similar amongst both as well.

Plus, medical textbooks and references will typically address it as one entity. For example, https://books.google.ca/books?id=2C2MAwAAQBAJ&pg=PA1086#v=onepage&q&f=false (same reference used previously) as well as UpToDate. Jpola3399 (talk) 21:59, 15 November 2023 (UTC)

I agree - it is rather unbalanced, recall I just wanted the opioid bit in there - I confess I did not really read it as a layperson might. I'm more in the cardiac primary care area - and we all want to focus on a sub-specialty in 2023 - it is an easier life. As you say, it opens in a consistent manner then wraps a lot of other stuff in there.

Either make it cover the bigger topic of GI holes - upper GI - small bowel and above are just as serious - esophageal holes are more than a little bothersome to a patient - stomach problems are supercommon - OR descope it to discuss the opening part and keep it lower bowel only - and make two articles - could it be retitled and encompass the whole GI? - I imagine that is what you were doing before I messed it up - many apologies. I VOTE to make it all GI holes - mouth to anus - and change the bowel rupture deal - your thinking? BeingObjective (talk) 22:12, 15 November 2023 (UTC)

Yep I think it should be kept as mouth to anus, I'll change it back to that. Also if you read the original discussion in the article talk page in 2020, the authors already discussed whether "ruptured bowel" is synonymous with GI perf despite having the word bowel. I'll change the second term in the title to GI rupture but it doesn't really make a difference to me. Jpola3399 (talk) 22:25, 15 November 2023 (UTC)

I think this is fine - BeingObjective (talk) 22:34, 15 November 2023 (UTC)