PERFORATED PEPTIC ULCER
(Frequently duodenal & at times stomach)
Section Editor : Prof. T.K. Parthasarathy
- Dramatic onset
- Felt something giving away inside !
- Generalised abdominal pain
- Patient is holding on to the abdomen and is afraid to move or turn.
- May or may not have fever.
- Anxious _ uncomfortable in pain.
Palpation : Tenderness (Severe). Rebound tenderness
Rigidity: Often described as board like rigidity. (Rather classic).
Percussion : Liver dullness is lost (Obliterated) (meaning free air in peritoneum)
Chest x-ray- upright - Usual finding _ presence of free air under the diaphragm.
If clinical suspicion is high and there is no air under the diaphragm on an upright film do a lateral decubitus.
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