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ULCER (PGU)
CASE SCENARIO
PR : Brownish stool
INTRODUCTION
Exacerbated by movement
Signs of peritonitis:
Rebound tenderness
DIAGNOSIS OF PGU
HISTORY TAKING
known peptic ulcer disease that has been inadequately treated or with ongoing symptoms and
sudden exacerbation of pain can be suspicious for perforation.
PRESENTATION
PHYSICAL EXAMINATION
physical examination findings may be equivocal, and peritonitis may be minimal or absent,
particularly in patients with contained leaks
INVESTIGATION
Laboratory studies are not useful in the acute setting as they tend to be nonspecific, but
leukocytosis, metabolic acidosis, and elevated serum amylase may be associated with
perforation
Free air under the diaphragm found on an upright chest X-ray is indicative of hollow organ
perforation
DIFFERENTIAL DIAGNOSIS
Pancreatitis does not have such a sudden onset as perforated ulcer, high
serum amylase
Acute cholecystitis
MANAGEMENT
Fluid resuscitation
NBM
Nasogastric suction
MANAGEMENT OF PGU
- CONSERVATIVE
(2) Heart or lung disease, which increases the surgical and anaesthetic risks.
(3) The patient who is admitted after a day or two and is almost moribund
with diffuse peritonitis Associated with poor outcome
MANAGEMENT OF PGU
- OPERATIVE
Laparotomy
REFERENCE
Primary Surgery: Volume One: Non trauma. Chapter 5-The Surgery of the
stomach http://
www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x3617.html