Chapter 39: UGI Bleed- Perforated Peptic Ulcer

Question 1

What are the symptoms?

Answer 1

Acute onset of upper abdominal pain

Question 2

What is the differential diagnosis?

Answer 2

1. Acute pancreatitis
2. acute cholecystitis
3. perforated acute appendicitis
4. colonic diverticulitis
5. MI
6. any perforated viscus

Question 3

Which diagnostic tests are indicated?

Answer 3

X-ray: free air under diaphragm or in lesser sac in an upright CXR

Question 4

What is the initial treatment?

Answer 4

1. NPO: NGT (↓ contamination of the peritoneal cavity)
2. IVF/Foley catheter
3. Antibiotics/PPIs
4. Surgery

Question 5

What is a Graham patch?

Answer 5

Piece of omentum incorporated into the suture closure of perforation

Question 6

What type of perforated ulcer may present just like acute
pancreatitis?

Answer 6

Posterior perforated duodenal ulcer into the pancreas (i.e., epigastric pain radiating to the back; high serum amylase)

Question 7

What is the classic difference between duodenal and gastric ulcer
symptoms as related to food ingestion?

Answer 7

Duodenal = decreased pain
Gastric = increased pain

(Think: Duodenal = Decreased pain)