Perforated peptic ulcer

Question 1

Pathophysiology of perforated peptic ulcer

Answer 1

Perforated duodenal ulcer 1st part commonest (highest acid conc)
Perforated gastric ulcer
Perforated gastric carcinoma

Question 2

Symptoms of perforated peptic ulcer

Answer 2

Sudden onset severe pain in epigastrium then becoming more generalised
Vomiting
Peritonitis

Question 3

Differentials of perforated peptic ulcer

Answer 3

Pancreatitis
Acute cholecystitis
AAA
MI

Question 4

Investigations for perforated peptic ulcer

Answer 4

Bloods: U+E, amylase, CRP
ABG: ?mesenteric ischaemia
Urine dipstick
Erect CXR: Air under diaphragm in 70%
Abdo XR: Rigler's sign (air both sides of bowel wall)

Question 5

Treatment of perforated peptic ulcer

Answer 5

1) Resusitation: 
Nil By Mouth
Aggressive fluid resus
Analgaesia
Ceftriaxone and metronidazole
NG tube
2) Conservative:
If not peritonitic
Omentum may seal perforation spontaneously in 50%
3) Surgery:
Duodenal ulcer - abdo washout + omental patch repair
Gastric ulcer - excise ulcer and repair
4) Test and treat for H Pylori