Surgery Definition – What Is perforated peptic ulcer?
Surgery Definition – What Is perforated peptic ulcer?
Perforated peptic ulcer is commonly involving duodenal ulcer than gastric ulcer. Anterior dudodenal ulcer is typically more common to perforate than anterior duodenal ulcer. Perforation peptic ulcer may present with acute upper abdominal pain which later progress to become a generalized peptic ulcer. The history taken on patient with perforated peptic ulcer may focus on the characteristic of the pain which is located at the epigastrium and boring in nature which is gradually become generalized and worsen in nature. Any presenting symptoms such as vomiting or malaise need to be notify. History of Zolinger Ellison Syndrome and peptic ulcer disease need to be considered. Any medication history need to be confirmed such a steroids or NSAIDS or previous surgery for ulcer.
Patient may appear ill looking, lying still or appear Cushingoid secondary to the used of steroid. The hand may appear cool and clammy and tachycardia. The abdomen may be peritonitic. The abdomen may not move during respiration and tender mostly in the epigastrium. There will be rebound tenderness and guarding with reduction in bowel sound and tympany over the liver.
The investigation needed may include full blood count which may reveal increase in white blood count in peritonitis, urea and electrolytes due to vomiting, amylase just to rule out pancreatitis, liver function test to rule out cholecystitis and group and cross match for operation.
Radiological investigation may reveal chest x ray for free air under the diaphragm. Other includes ECG to rule out acute myocardial infarction.
The management of perforated peptic ulcer may include admission to the ward, nil by mouth and nasogastric tube, intravenous fluid and corrected electrolytes imbalance, catheterization, antibiotic such as cefuroxime and metronidazole, analgesia in the form of opiods and laparotomy.
The surgical operation may include exploratory laparotomy which can be performed by simple closure of the edge of the ulcer by apposition or using an omental patch known as Graham patch. This is later follow by copious irrigation of peritoneal cavity with warm saline.
Perforated peptic ulcer is commonly involving duodenal ulcer than gastric ulcer. Anterior dudodenal ulcer is typically more common to perforate than anterior duodenal ulcer. Perforation peptic ulcer may present with acute upper abdominal pain which later progress to become a generalized peptic ulcer. The history taken on patient with perforated peptic ulcer may focus on the characteristic of the pain which is located at the epigastrium and boring in nature which is gradually become generalized and worsen in nature. Any presenting symptoms such as vomiting or malaise need to be notify. History of Zolinger Ellison Syndrome and peptic ulcer disease need to be considered. Any medication history need to be confirmed such a steroids or NSAIDS or previous surgery for ulcer.
Patient may appear ill looking, lying still or appear Cushingoid secondary to the used of steroid. The hand may appear cool and clammy and tachycardia. The abdomen may be peritonitic. The abdomen may not move during respiration and tender mostly in the epigastrium. There will be rebound tenderness and guarding with reduction in bowel sound and tympany over the liver.
The investigation needed may include full blood count which may reveal increase in white blood count in peritonitis, urea and electrolytes due to vomiting, amylase just to rule out pancreatitis, liver function test to rule out cholecystitis and group and cross match for operation.
Radiological investigation may reveal chest x ray for free air under the diaphragm. Other includes ECG to rule out acute myocardial infarction.
The management of perforated peptic ulcer may include admission to the ward, nil by mouth and nasogastric tube, intravenous fluid and corrected electrolytes imbalance, catheterization, antibiotic such as cefuroxime and metronidazole, analgesia in the form of opiods and laparotomy.
The surgical operation may include exploratory laparotomy which can be performed by simple closure of the edge of the ulcer by apposition or using an omental patch known as Graham patch. This is later follow by copious irrigation of peritoneal cavity with warm saline.
