Chapter 30 Perforated Ulcer Flashcards
What is a differential diagnosis for a patient who has severe burning epigastric pain with h of intermittent epigastric discomfort and tension HA?
Gastritis PUD, Acute pancreatitis , Lower lobe pneumonia, MI, ruptured abdominal aortic aneurysm
What are the emergency orders?
IV acres, Pulse Ox, Bp and cardiacs monitor, ECG
What are the physical findings for ruptured peptic ulcer?
Diaphoresis absent BS, rigid and extremely tender abdomen with rebound tenderness
What are the diagnostic investigations to confirm ruptured peptic ulcer disease?
CBC BMP LFT Serum Amylase, Lipase, abdominal and upright Chest XR, cancel ibuprofen
What can be used if AXR is negative?
CT scan or ultrasound can assist in detecting small amounts of air or fluid
What does the pre-operative management for this patient consist of?
NG tube, IV antibiotics, antiemetic, analgesics, PPIs, General surgery consultation, PT, PTT/INR, T&C
What is the IV antibiotic regimen for these patients?
Beta lactam/beta lactamase (piptazo ampsulbact ticarcillin-clavulanate) or Metronidazole and third generation cephalosporins
In the case would you choose non-operative conservative management over emergent surgery?
If surgery is high risk due to comorbidities, or a clinically stable patient with small leak or a presumptive spontaneous ceiling for imaging
What would mandate a Surgical intervention in patient that has been managed conservatively initially?
No improvement with 12 hours of conservative management
When she need therapy be initiated for this patient?
Right after the radiographic findings of pneumoperitoneum
