Perforated Peptic Ulcer

PERFORATED PEPTIC ULCER


PERFORATED PEPTIC ULCER

  • More common in males.
  • In females, elderly patients are most commonly affected.

Etiology-

  • Chronic use of NSAIDs
  • H. Pylori infection

Clinical features-

  • Classical presentation of perforated duodenal ulcer- patients develop sudden- onset of severe generalised abdominal pain on peritoneum.
  • Abdomen exhibits broad like rigidity & does not move with respiration.
  • Pain in epigastrium and right iliac fossa.
  • Most common site of perforation is anterior aspect of duodenum.
  • Gastric ulcers perforate at the antrum or incisural and into the lesser sac.
  • Tenderness and rebound tenderness (Blumberg sign) is over abdomen.

Investigations-

  1. Complete blood picture.
  2. Plain X- ray chest or abdomen in erect position shows collection of free gas under right dome of diaphragm (75- 80%)
  3. Serum amylase test should be performed.
  4. CT- scan and contrast can show site of perforation and pneumoperitoneum.

Treatment-

  1. Aspiration of stomach contents with Ryle’s tube.
  2. Drugs- inj. Ampicillin 500mg iv
  • Inj. Gentamincin 60- 80mg iv
  • Inj. Metronidazole- 500 mg iv

3. Fluids

4. Emergency laprotomy

5. Surgery- Commonly performed surgery is simple patch close i.e. omental patch.

Exam Important

Etiology-

  • Chronic use of NSAIDs
  • H. Pylori infection

Clinical features-

  • Most common site of perforation is anterior aspect of duodenum.
  • Gastric ulcers perforate at the antrum or incisural and into the lesser sac.
  • Tenderness and rebound tenderness (Blumberg sign) is over abdomen.

Investigations-

  1. Complete blood picture.
  2. Plain X- ray chest or abdomen in erect position shows collection of free gas under right dome of diaphragm (75- 80%)
  3. Serum amylase test should be performed.
  4. CT- scan and contrast can show site of perforation and pneumoperitoneum.
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