PERFORATED PEPTIC ULCER

(Frequently duodenal & at times stomach)

Section Editor : Prof. T.K. Parthasarathy

History :

• 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.
• Tachycardia+
• Anxious _ uncomfortable in pain.

Finding:

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)

Work-ups :

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.