Perforated peptic ulcer Flashcards
What are the symptoms of perforated peptic ulcer?
Acute onset of upper abdominal pain
What causes pain in the lower quadrants?
Passage of perforated fluid along colic gutters
What are the signs of perforated ulcers?
Decreased bowel sounds, tympanic sound over the liver (air), peritoneal signs, tender abdomen
What are the sings of posterior duodenal erosion/perforation?
Bleeding from gastroduodenal artery (and possible acute pancreatitis)
What sign indicates anterior duodenal perforation?
Free air (anterior perforation is more common than posterior)
What is the differential diagnsosis
Acute pancreatitis acute chole perforated acute AP colonic diverticulitis MI any perforated viscus
Xray results
free air under diaphragm in lesser sac in upright CXR
What are the associated lab findings?
Leukocytosis, high amylase serum
What is the initial treatment?
NPO: NGT
IVF/FC
Antibiotics/PPIs
Surgery
What is graham patch?
a piece of omentum incorporated into the suture closure of perforation
What are the surgical options?
Graham patch
Truncal vagotomy and pyloroplasty
What is the significance of hemorrhage and perforation with duodenal ulcer?
may indicate kissing ulcers: posterior is bleeding and anterior is perforated with free air
What type of perforated ulcer may present just like acute pancreatitis
Posterior perforated duodenal ulcer into the pancrease
What is the classic difference between duodenal and gastric ulcer symptoms as related to food ingestion?
Duodenal=decreased pain
Gastric=increased pain
(Think Duodenal=Decreased pain
