Perforated Peptic Ulcer

Question 1

What is more common, a perforated GU or DU?

Answer 1

DU

Question 2

What are the three stages in the clinical syndrome of perferated peptic ulcer?

Answer 2

1. prostration
2. reaction (after 2-6 hours) where sx improved
3. peritonitis (after 6-12 hours)

Question 3

Clinical features of perforated peptic ulcer

Answer 3

• Sudden onset severe epigastric pain
• Continuous pain but lessens for a few hours (stage 2)
• Epigastric pain at first and then generalised to whole abdomen (perforation, then peritonitis)
• Pain may radiate to one or both shoulders or RLQ
• Nausea and vomiting (delayed)
• Hiccough is a common late symptom

Question 4

Signs of perforated peptic ulcer

Answer 4

• Patient lies quietly (pain aggravated by movement and coughing)
• Pale, sweating or ashen at first
• Board-like rigidity
• Guarding
• Maximum signs at point of perforation
• No abdominal distension
• Contraction of abdomen: forms a shelf over lower chest
• Bowel sounds reduced (silent abdo)
• Shifting dullness may be present
• Pulse, temp, BP normal at first -> then tachycardia and shock later

Question 5

PR will find —?

Answer 5

pelvic tenderness

Question 6

Xray will show…?

Answer 6

Free air under diaphragm (in 75% of cases)

* NB need to sit upright for 15 minutes before

Question 7

Management of perforated PU

Answer 7

Pain relief
Drip and suction
Broad spectrum antibiotics
Immediate laparotomy after resuscitation