Perforated Peptic Ulcer

Question 1

Presentation?

Answer 1

Sudden onset, severe epigastric pain, worse on coughing and moving, may radiate to shoulder and whole abdomen. Recent ‘indigestion’ symptoms. Absent bowel sounds. Shock. Peritonitis and fever

• Heamatemesis (bright red, dark clots, coffee grounds)
• Melaena (black, sticky, smelly)
• Weakness/sweating and palpitations
• Postural dizziness and fainting
• Collapse or shock

Question 2

Investigations?

Answer 2

Bloods: FBC, U&E’s, glucose, amylase (high), G&S, X-match
ABG
CXR (erect) - free air under diaphragm
Contrast CT - for clarity

Question 3

Mx?

Answer 3

ABCDE
Oxygen
IV Opiod
IV metoclopramide
IV PPI (omeprazole 80 mg)
Fluids
O neg blood - if massive haemorrhage
IV antibiotics – cefotaxime 1g + metronidazole 500mg
Refer to surgeons - Laparotomy

Question 4

What is particularly high in U&E’s?

Answer 4

Urea