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Peptic Ulcer Styled Table

A perforated peptic ulcer is a severe complication of peptic ulcer disease characterized by sudden, severe abdominal pain and board-like rigidity. Diagnosis involves imaging to detect free air under the diaphragm, and it requires immediate surgical intervention to prevent complications like sepsis. Associated symptoms include nausea, vomiting, and signs of shock, with management focusing on resuscitation and surgical repair.

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Ayuub Abdirizak
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29 views2 pages

Peptic Ulcer Styled Table

A perforated peptic ulcer is a severe complication of peptic ulcer disease characterized by sudden, severe abdominal pain and board-like rigidity. Diagnosis involves imaging to detect free air under the diaphragm, and it requires immediate surgical intervention to prevent complications like sepsis. Associated symptoms include nausea, vomiting, and signs of shock, with management focusing on resuscitation and surgical repair.

Uploaded by

Ayuub Abdirizak
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Perforated Peptic Ulcer: Comprehensive Guide

Overview

A perforated peptic ulcer is a serious complication of peptic ulcer disease (PUD) where an ulcer erodes through the
stomach or duodenal wall, leading to leakage of gastric or duodenal contents into the peritoneal cavity. This causes chemical
peritonitis initially, which can progress to bacterial peritonitis if not treated promptly.

Clinical Presentation

Sudden Onset of Severe Pain Pain is typically acute, severe, and diffuse
Starts in epigastrium (upper abdomen)
Spreads to entire abdomen
May radiate to shoulders (referred pain)

Abdominal Rigidity Becomes board-like (rigid)


Due to involuntary guarding from peritoneal irritation

Systemic Signs Tachycardia


Hypotension
Signs of shock
Fever may develop later

Associated Symptoms Nausea and vomiting


History of PUD
NSAID use
Helicobacter pylori infection

Physical Exam Findings

Diffuse tenderness and rebound tenderness: Present across entire abdomen


Guarding and rigidity: Hard and rigid ("board-like") abdomen
Absent bowel sounds: Due to paralytic ileus
Lost hepatic dullness: May disappear due to free air under diaphragm

Diagnostic Workup

Imaging Erect Chest X-ray or Abdominal X-ray:


Look for free air under diaphragm (pneumoperitoneum)
CT scan:
Detect free air, fluid collections, perforation site

Laboratory Tests Elevated WBC (leukocytosis)


Elevated lactate
Amylase and lipase tests

Management

Resuscitation Intravenous fluids


Antibiotics (gram-negative and anaerobic coverage)
Pain management
Nasogastric tube insertion

Surgical Repair Laparoscopic or open surgery


Omental patch (Graham patch) when needed

Postoperative Care Treat underlying H. pylori infection


Proton pump inhibitors (PPIs)
Avoid NSAIDs

Differential Diagnosis Comparison

Feature Perforated Peptic Ulcer Appendicitis Peritonitis


Onset of Pain Sudden, severe, and Gradual, starts periumbilical, migrates Depends on cause
diffuse to RLQ

Pain Location Epigastrium initially, then Localized to RLQ Diffuse


diffuse

Abdominal Exam Board-like rigidity, guarding Localized RLQ tenderness Diffuse tenderness, rigidity,
guarding

Systemic Tachycardia, hypotension, Low-grade fever, mild tachycardia High fever, tachycardia,
Symptoms shock hypotension

Bowel Sounds Absent Normal or hyperactive early Absent

Imaging Free air under diaphragm Thickened appendix on CT/US Free air, abscess, or
Findings perforation

Summary

Presents with sudden, severe abdominal pain


Board-like rigidity is characteristic
Free air under the diaphragm on imaging is diagnostic
Must be differentiated from appendicitis and peritonitis
Requires immediate surgical intervention
Crucial to prevent complications like sepsis and death

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