Clinical Presentation of Gastric Ulcers Explained by Dhruv Rathee
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- A 60-year-old man presented with severe abdominal pain for 1 day. His examination showed a pulse of 120 bpm and diffuse abdominal guarding. A chest X-ray revealed free air under his right hemidiaphragm. - His history indicated chronic back pain treated with NSAIDs and recent worsening abdominal pain. - Based on his presentation of pneumoperitoneum, the provisional diagnosis was a perforated peptic ulcer leading to pneumoperitoneum. Peptic ulcers can be caused by H. pylori infection, NSAID use, or Zollinger-Ellison syndrome. Perforation is a complication that is usually treated with broad-spectrum antibiotics and surgery such
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Mr. Sankappa
Definition
Gastro esophageal reflux disease is a chronic and relapsing condition in which prolonged reflux of hydrochloric acid, pepsin and bile salts in the esophagus, oral cavity and respiratory system occurs that leads to esophagitis
Excessive intake of junk foods, coffee, chocolate
Excessive intake of onion, tomato, and beverages
Heavy exercise
Alcoholic and smoking
Medications
Heartburn
Discomfort
Chest pain
Difficulty in respiration
Aspiration pneumonia
After endoscopy the lesions are graded for severity using the Savary Miller grading system;
Grade 1: single or multiple erosions on a single fold.
Grade 2: multiple erosions affecting multiple folds. Erosions may be confluent.
Grade 3: multiple circumferential or rounded erosions.
Grade 4: ulcer, stenosis or esophageal shortening.
Grade 5: Barrett's epithelium. Columnar metaplasia (cellular changes on the microscopic level) in the form of circular or non-circular (islands or tongues) extensions.
Pathophysiology
Management
Antacids: An antacid is a substance which neutralizes stomach acidity, used to relieve heartburn, indigestion or an upset stomach (ex: Rantac, Zantac)
H2receptor antagonist: H2 antagonists block histamine-induced gastric acid secretion from the parietal cells of the gastric mucosa. They include cimetidine, famotidine, nizatidine
Proton Pump Inhibitors: Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid (Omeprazole, Rabeprazole, pantoprazole)
Cholinergic drugs:Cholinergic drug, any of various drugs that inhibit, enhance, or mimic the action of the neurotransmitter (acetylcholine, carbachol, methacholine)
Cytoprotective drugs: is a process by which chemical compounds provide protection to cells against harmful agents (carbenoxolone, sucralfate, misoprostol)
Prokinetic drugs: prokinetic, is a type of drug which enhances gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm. (Benzamide, Cisapride, Domperidone).
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This document provides an overview of abdominal pain, including:
1. It describes the anatomy of the abdominal wall and peritoneum, including the parietal and visceral layers.
2. It defines pain and lists common stimulants of pain including mechanical trauma, heat/cold, chemicals, and radiation.
3. It distinguishes between visceral and somatic pain, noting that visceral pain is diffuse and poorly localized while somatic pain is sharp and well-localized.
4. Causes of abdominal pain are categorized as abdominal, extra-abdominal, systemic dysfunction, or functional/abdominal wall pain. Types of pain including referred pain are also described.
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GERD is caused by pathological reflux of gastric or duodenal contents into the esophagus past the lower esophageal sphincter. It is the most common upper GI condition in western countries. Diagnosis involves endoscopy, pH monitoring, and manometry. Treatment includes lifestyle changes, proton pump inhibitors, fundoplication surgery, and newer endoscopic procedures. Complications may include esophagitis, stricture, Barrett's esophagus, and adenocarcinoma if left untreated.
Esophageal and extraesophageal management of GERD
1) Gastroesophageal reflux disease (GERD) occurs when gastric contents reflux into the esophagus in excessive amounts, causing symptoms or mucosal injury.
2) Common symptoms include heartburn and regurgitation. Complications include esophagitis, strictures, and Barrett's esophagus.
3) Diagnosis is usually made clinically based on symptoms. Testing with endoscopy, pH monitoring, or impedance monitoring may be used to confirm diagnosis or assess for complications.
4) Treatment involves lifestyle modifications and medication like antacids, H2 blockers, or proton pump inhibitors. Reflux surgery may be considered for severe cases.
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This document discusses intestinal obstruction, including its causes, signs and symptoms, assessments, nursing diagnoses, and treatment. Intestinal obstruction can be mechanical or functional and causes a blockage in the small or large intestine. Common signs are abdominal pain, nausea, vomiting, and constipation. Assessments include physical exams, imaging, and labs. Nursing focuses on relieving pain, maintaining fluid and electrolytes, and preparing for possible surgery. Treatment involves correcting the underlying cause through medical or surgical management.
Acute abdominal pain
1) Between one-third to one-half of children admitted to the hospital for acute abdominal pain have non-specific abdominal pain, while another one-third have acute appendicitis.
2) A careful history, physical exam, and observation are important for evaluating acute abdominal pain in children. Additional tests like ultrasound, urine analysis, and bloodwork may also help diagnose conditions like UTIs, gastrointestinal issues, or appendicitis.
3) Non-specific abdominal pain is poorly localized, not worsened by movement, and rarely accompanied by guarding. It is usually self-limiting within 24 hours and may be caused by viral infections or transient intussusception.
Acute Abdomen .pptx
The document discusses acute abdomen, defined as sudden abdominal pain lasting less than 24-72 hours. It summarizes the key points as:
1) Abdominal pain is the primary symptom and can be visceral, parietal, or referred pain.
2) Causes are divided into surgical (such as inflammation, perforation, obstruction), gynecological/obstetrical, medical, and non-specific.
3) Diagnosis involves history, physical exam focusing on abdominal tenderness and guarding, basic labs, and imaging like ultrasound or CT scan to identify potential causes like appendicitis or bowel obstruction.
Abdominal Examination
1) The document provides guidelines for performing an abdominal examination, including inspection, palpation, percussion, and auscultation.
2) Seven sample patient cases are described to demonstrate how findings from the abdominal exam can be used to arrive at diagnoses. Diagnoses included fatty liver, splenomegaly, sigmoid carcinoma, ascites, hydronephrosis, carcinoid tumor, and schwannoma.
3) Performing a thorough abdominal exam through inspection, palpation, percussion, and auscultation is important for identifying abnormalities and arriving at accurate diagnoses.
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GERD
Mr. Sankappa
Definition
Gastro esophageal reflux disease is a chronic and relapsing condition in which prolonged reflux of hydrochloric acid, pepsin and bile salts in the esophagus, oral cavity and respiratory system occurs that leads to esophagitis
Excessive intake of junk foods, coffee, chocolate
Excessive intake of onion, tomato, and beverages
Heavy exercise
Alcoholic and smoking
Medications
Heartburn
Discomfort
Chest pain
Difficulty in respiration
Aspiration pneumonia
After endoscopy the lesions are graded for severity using the Savary Miller grading system;
Grade 1: single or multiple erosions on a single fold.
Grade 2: multiple erosions affecting multiple folds. Erosions may be confluent.
Grade 3: multiple circumferential or rounded erosions.
Grade 4: ulcer, stenosis or esophageal shortening.
Grade 5: Barrett's epithelium. Columnar metaplasia (cellular changes on the microscopic level) in the form of circular or non-circular (islands or tongues) extensions.
Pathophysiology
Management
Antacids: An antacid is a substance which neutralizes stomach acidity, used to relieve heartburn, indigestion or an upset stomach (ex: Rantac, Zantac)
H2receptor antagonist: H2 antagonists block histamine-induced gastric acid secretion from the parietal cells of the gastric mucosa. They include cimetidine, famotidine, nizatidine
Proton Pump Inhibitors: Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid (Omeprazole, Rabeprazole, pantoprazole)
Cholinergic drugs:Cholinergic drug, any of various drugs that inhibit, enhance, or mimic the action of the neurotransmitter (acetylcholine, carbachol, methacholine)
Cytoprotective drugs: is a process by which chemical compounds provide protection to cells against harmful agents (carbenoxolone, sucralfate, misoprostol)
Prokinetic drugs: prokinetic, is a type of drug which enhances gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm. (Benzamide, Cisapride, Domperidone).
Endoscopic intraluminal valvuloplasty
Gastric tissue is utilised to increase the integrity of LES By creating a valve like structure.
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Acute abdomen is an abdominal emergency that requires prompt evaluation and treatment. Patients often present in the evening with sudden onset abdominal pain within the last 24 hours. A thorough history and physical exam are important to determine the cause, which can include appendicitis, cholecystitis, pancreatitis, diverticulitis, perforated ulcer, bowel obstruction, mesenteric ischemia, or ruptured abdominal aortic aneurysm. Diagnostic testing may include bloodwork, imaging studies like ultrasound or CT scan, and surgery if indicated by the condition. Proper diagnosis and management are needed to prevent complications.
Abdominal pain
This document provides an overview of abdominal pain, including:
1. It describes the anatomy of the abdominal wall and peritoneum, including the parietal and visceral layers.
2. It defines pain and lists common stimulants of pain including mechanical trauma, heat/cold, chemicals, and radiation.
3. It distinguishes between visceral and somatic pain, noting that visceral pain is diffuse and poorly localized while somatic pain is sharp and well-localized.
4. Causes of abdominal pain are categorized as abdominal, extra-abdominal, systemic dysfunction, or functional/abdominal wall pain. Types of pain including referred pain are also described.
Gsatritis
Gastritis is an inflammation of the stomach lining that can be acute or chronic. Acute gastritis develops suddenly while chronic gastritis persists over a long period of time. Common causes include bacterial infections, NSAIDs, autoimmune disorders, and bile reflux. Symptoms may include abdominal pain, bloating, weight loss, and nausea or vomiting. Diagnosis involves medical history, physical exam, and tests like blood tests, stool tests, or endoscopy. Treatment focuses on antacids, H2 blockers, PPIs, antibiotics, and managing pain or nutrition imbalances. Prevention emphasizes diet, avoiding alcohol/smoking, exercise, and stress management.
Gastro esophageal reflux disease
GERD is caused by pathological reflux of gastric or duodenal contents into the esophagus past the lower esophageal sphincter. It is the most common upper GI condition in western countries. Diagnosis involves endoscopy, pH monitoring, and manometry. Treatment includes lifestyle changes, proton pump inhibitors, fundoplication surgery, and newer endoscopic procedures. Complications may include esophagitis, stricture, Barrett's esophagus, and adenocarcinoma if left untreated.
Esophageal and extraesophageal management of GERD
1) Gastroesophageal reflux disease (GERD) occurs when gastric contents reflux into the esophagus in excessive amounts, causing symptoms or mucosal injury.
2) Common symptoms include heartburn and regurgitation. Complications include esophagitis, strictures, and Barrett's esophagus.
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4) Treatment involves lifestyle modifications and medication like antacids, H2 blockers, or proton pump inhibitors. Reflux surgery may be considered for severe cases.
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1) Between one-third to one-half of children admitted to the hospital for acute abdominal pain have non-specific abdominal pain, while another one-third have acute appendicitis.
2) A careful history, physical exam, and observation are important for evaluating acute abdominal pain in children. Additional tests like ultrasound, urine analysis, and bloodwork may also help diagnose conditions like UTIs, gastrointestinal issues, or appendicitis.
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Similar to Clinical Presentation of Gastric Ulcers Explained by Dhruv Rathee
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The document discusses acute abdomen, defined as sudden abdominal pain lasting less than 24-72 hours. It summarizes the key points as:
1) Abdominal pain is the primary symptom and can be visceral, parietal, or referred pain.
2) Causes are divided into surgical (such as inflammation, perforation, obstruction), gynecological/obstetrical, medical, and non-specific.
3) Diagnosis involves history, physical exam focusing on abdominal tenderness and guarding, basic labs, and imaging like ultrasound or CT scan to identify potential causes like appendicitis or bowel obstruction.
Abdominal Examination
1) The document provides guidelines for performing an abdominal examination, including inspection, palpation, percussion, and auscultation.
2) Seven sample patient cases are described to demonstrate how findings from the abdominal exam can be used to arrive at diagnoses. Diagnoses included fatty liver, splenomegaly, sigmoid carcinoma, ascites, hydronephrosis, carcinoid tumor, and schwannoma.
3) Performing a thorough abdominal exam through inspection, palpation, percussion, and auscultation is important for identifying abnormalities and arriving at accurate diagnoses.
Avoiding errors in diagnosing abdominal pain
This document provides guidance on evaluating and diagnosing abdominal pain. It emphasizes the importance of thorough history taking and examination. Key vital signs and pain scores should be assessed. Analgesics can be given early without delaying diagnosis. Stability must be reassessed after interventions. Specific considerations are provided for different age groups and gender. Common patterns associated with various diagnoses are outlined. Four case studies are presented highlighting errors in diagnosis, including appendicitis mistaken for wall abscess, hernia nerve entrapment, testicular torsion, and opioid overdose masked by vague complaints. The takeaway is to be diligent and persistent until reaching a diagnosis.
Acuteappendicitis
Acute appendicitis is caused by obstruction of the appendix lumen, which increases intraluminal pressure and leads to tissue ischemia, necrosis, and potential perforation. It presents with initially vague periumbilical pain that migrates to the right lower quadrant. Diagnosis is suggested by tenderness over McBurney's point on exam. Imaging such as CT can help diagnosis but is not always needed. Treatment is appendectomy with preoperative antibiotics. Patients may be observed briefly if diagnosis is uncertain.
class acute abdomen other causes.pdf PPT.pdf
This document discusses various causes of acute abdominal pain, including non-specific abdominal pain (34%), acute appendicitis (28%), acute cholecystitis (10%), small bowel obstruction (4%), perforated peptic ulcer (3%), pancreatitis (3%), and diverticular disease (2%). It describes the pathophysiology of visceral, parietal, and referred pain. It provides details on localized pain patterns from various abdominal organs and conditions. It also outlines the important history, physical exam findings, and initial investigations for evaluating a patient with acute abdominal pain.
Acute abdomen approach to managment-hazem
This document provides an overview of the management approach for acute abdomen. It begins with definitions and epidemiology, noting that acute abdomen is undiagnosed abdominal pain lasting less than 7-10 days. It then covers the surgical and medical causes, with etiological classifications including inflammatory/infective, perforation, obstruction, infarction, and spontaneous bleeding. Differential diagnoses are provided for different age groups. The management approach involves clinical evaluation, resuscitation, diagnostic tools like ultrasound and CT scan, and categorizing patients based on urgency of condition.
Medical surgical nursing-1 2nd year B.sc nursing blueprint question solution...
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Appendicitis
This case presentation summarizes a 12-year-old male patient who presented with abdominal pain, vomiting, and fever. On examination, the patient had tenderness and rebound tenderness in the right lower quadrant. Ultrasound showed an enlarged appendix measuring 8.5 cm in diameter with probe tenderness. The patient was diagnosed with acute appendicitis and underwent an appendicectomy. Post-operatively, the patient was treated with IV antibiotics and analgesics. The appendix was found to be retrocaecal and reactive fluid was present.
Acute abdomen the lect .ppt
the acute abdomen what are the causes how to reach to rapid and nearly accurate diagnosis decisions in priorities of treatment and prognosis
4522504.ppt
This document discusses the evaluation and differentiation of acute abdominal pain as either surgical or nonsurgical in nature. It provides details on:
1. Characteristics that suggest a surgical condition include sudden onset of severe, continuous pain not relieved by changing position that began during rest and localized pain that shifts locations.
2. Nonsurgical conditions typically present with gradual onset of intermittent pain that is relieved by changing position and preceded by nausea.
3. The physical exam involves inspection, auscultation, palpation and focuses on vital signs, pain localization, and rebound tenderness to differentiate surgical from nonsurgical disorders.
ACUTE ABDOMEN SLIDES PRESENTATION ABDOMEN
This document discusses the acute abdomen and provides details on:
- The definition and primary symptom (abdominal pain) of an acute abdomen.
- The quadrants and regions of the abdomen.
- Types of abdominal pain and clinical presentation of abdominal problems.
- Specific diseases including acute gastritis, perforated peptic ulcer, acute cholecystitis, cholelithiasis, ascending cholangitis, acute pancreatitis, abdominal aortic aneurysm, intestinal obstruction, and acute mesenteric ischemia.
- For each disease, it discusses the pathology, history, physical exam findings, investigations, management, and complications.
Acute abdomen the lect
The acute abdomen refers to an acute change in the intra-abdominal organs requiring immediate diagnosis. A thorough history and physical exam can identify the cause in most cases. The exam involves inspection, auscultation, percussion, and palpation with attention to signs of peritonitis like rebound tenderness. Careful assessment of pain characteristics, fever, vomiting, and vital signs along with the physical exam can diagnose many acute abdominal conditions. Further tests should only be used if needed to establish a working diagnosis for treatment.
A case study on Pangastritis with pancreatitis
this case study describes about Pangastritis with pancreatitis , which details about the treatment, management , diagnosis, patient counselling, pharmacist interventions & discussions are followed in this case .
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PSEUDOPANCREATIC CYST
Case Presentation acts as a demo for Abdominal Cases.
Outline of Management of Pseudopancreatic cysts
Recent Advances
Enteric Fever Paediatrics CPC Fasih.pptx
Enteric fever is caused by Salmonella typhi and paratyphi bacteria which are transmitted through contaminated food or water. It presents with prolonged fever, abdominal pain, and diarrhea. Investigations show leukopenia and positive blood or stool cultures. Management involves supportive care and antibiotics like cefixime or fluoroquinolones for 1-2 weeks. Complications include intestinal bleeding, perforation and rarely meningitis. Prognosis is good with treatment but relapses or chronic carriage can occur.
Acute Abdomen.pptx
Acute abdomen and appendicitis are medical emergencies that require prompt diagnosis and treatment. The document discusses the clinical presentation of acute abdomen, with a focus on acute appendicitis. Key signs of acute appendicitis include abdominal pain that starts around the umbilicus and later localized to the right lower quadrant, as well as nausea, vomiting, fever and rebound tenderness on physical exam. A diagnosis is typically made clinically based on history and exam findings, supported by blood tests and imaging as needed. Treatment involves surgical removal of the appendix (appendectomy), most often via laparoscopy. Delays in diagnosis and treatment can lead to complications from appendicitis.
GERD ppt.pptx
This document presents a case report of a 43-year-old male patient presenting with symptoms of gastroesophageal reflux disease (GERD) including mid-epigastric pain, chest burning, dry cough, and occasional regurgitation. On physical examination, his vital signs and physical exam were normal. The document then provides questions and answers about differential diagnoses, definitions, and management approaches for GERD. Key points addressed include the spectrum of GERD, from symptoms to complications like esophagitis, stricture, and Barrett's esophagus. Empiric PPI therapy is discussed as an initial management strategy.
Choledochal cyst (type IVb) with Cholangitis
The document summarizes the case of a 10-year-old boy admitted with fever, jaundice, and abdominal pain. Key findings include intermittent high fever for 4 days, jaundice for 4 days, and occasional right upper abdominal pain. He had a similar prior episode 2 months ago. Examination found him febrile but otherwise stable. Tests showed elevated liver enzymes and bilirubin. Ultrasound and MRCP found a fusiform dilated common bile duct suggestive of a choledochal cyst. He was started on antibiotics and vitamin K. His fever subsided after a few days but jaundice remained. A pediatric surgery consultation was requested.
L20-Acute Abdomen.pdf
The document provides an overview of the approach to acute abdomen. It defines acute abdomen and outlines the general approach using the SOAP method - taking a history, performing a physical exam, ordering investigations, and creating a treatment plan. Common causes of acute abdomen are then discussed through various case scenarios involving factors like age, location of pain, onset, character, and associated symptoms. A detailed guide is given for examining the abdomen and evaluating vital signs, jugular venous pressure, lymph nodes, and potential referrals from other organ systems. Key blood tests are also outlined to check for indicators of issues like infection, hemorrhage, or electrolyte imbalances.
Similar to Clinical Presentation of Gastric Ulcers Explained by Dhruv Rathee (20)
Acute Abdominal Pain MS-General surgery lecture.ppt
Acute Abdominal Pain MS-General surgery lecture.ppt
Medical surgical nursing-1 2nd year B.sc nursing blueprint question solution...
Medical surgical nursing-1 2nd year B.sc nursing blueprint question solution...
Clinical Presentation of Gastric Ulcers Explained by Dhruv Rathee
- 1. Surgery Case Presentation ADITYA DINESH - 180101218 ADITIJ DHAMIJA - 180101220
- 2. Scenario •A 60 year old man presents with severe abdominal pain since 1 day. On examination, pulse is 120bpm. •There is diffuse guarding of abdomen. •Chest X-ray shows free air under right hemidiaphragm.
- 3. Demographic Details •Name – Salman Khan •Age – 60 years •Sex – Male •Occupation – Driver •Address – Bandra, Mumbai
- 4. Chief Complaints •Severe abdominal pain since 1 day which is recalcitrant to over the counter pain medication •Palpitations
- 5. History of Present Illness •The patient was apparently normal 3 days back when started feeling mild upper abdominal pain which occurred 3 hours after meal. •The pain was insidious in onset following the meal and was associated with symptoms of bloating, abdominal fullness and nausea. Patient reported early satiety. •The pain was relieved on taking antacids. •1 day ago patient developed sudden severe and diffuse abdominal pain with palpitations. •Pain began in the evening and worsened before dissipating completely. •Then a more constant pain developed insidiously which has progressively increased, the pain also radiates towards the right shoulder. •There was blackish discoloration of stools.
- 6. Past History There is history of chronic back pain which is relieved by NSAIDs.
- 7. Treatment History Patient has been taking NSAIDs daily for the past 6 months due to chronic back pain.
- 8. Personal History •There is history of constipation •Bladder habits are normal •Patient reported waking up at 1-2AM in the past 3 days. •The patient was anorexic •Diet – Mixed
- 9. Family History There is no history of any similar complaints in any other family members
- 11. Causes of Diffuse Abdominal Pain
- 12. Differential Diagnosis Peptic ulcer perforation Acute pancreatitis – Pain, rigidity but no fever. Functional dyspepsia – Pain and early satiety Gastroparesis – Post prandial fullness Acute myocardial infarction – No previous heart symptoms Acute mesenteric ischemia – Post prandial pain Adrenal insufficiency Spontaneous bacterial peritonitis Colorectal cancer
- 13. General Physical Examination Patient has reduced body build, conscious and oriented to time, place and person. Vitals: Pulse – 120 / min BP – 120/82 mm Hg Temperature – 100 F Respiratory rate – 16 breaths/ minute Slight pallor is seen. No icterus, cyanosis, clubbing, cervical lymphadenopathy and edema seen. Abdominal facies was seen.
- 14. Local Examination •The patient was made to lie flat on his back with legs extended. The whole abdomen from the nipples above down to the saphenous openings was exposed. Inspection: 1. Distension of abdomen was observed with scaphoid appearance. 2. Restricted abdominal movement on respiration was seen. 3. Discomfort on gently coughing. Swelling, Discoloration of skin absent. No scars or sinuses seen. No superficial veins are seen over the abdomen.
- 15. Palpation: 1. There was rigidity of abdominal wall 2. Tenderness was elicited on light palpation over the epigastrium region. 3. Rebound tenderness is seen. No palpable mass found in the abdomen. There was no enlargement of Liver or Spleen. Pain on abdominal percussion. No significant findings on Auscultation.
- 16. Provisional Diagnosis PERFORATED PEPTIC ULCER LEADING TO PNEUMOPERITONEUM
- 17. Peptic Ulcer ETIOPATHOGENESIS:- It can be caused due to: 1. H. pylori infection 2. Consumption of NSAIDS 3. Increased acid production in case of gastrinomas such as Zollinger-Ellison syndrome Cigarette smoking is a risk factor. Peptic ulcer can lead to malignancy in the stomach.
- 18. Clinical features 1. Intermittent pain in the epigastrium is seen, which may radiate to the back. 2. Symptoms may disappear and appear after weeks or months due to spontaneous healing of ulcer. 3. Vomiting 4. Weight loss 5. Melena or Hematemesis can be seen due to bleeding. 6. Epigastric tenderness 7. Bloating sensation and nausea
- 19. Complications (Peptic Ulcer) •Haematemesis, melena, hematochezia, orthostatic hypotension •Gastric outlet obstruction •Gastrocolic or duodenocolic fistulas •Perivisceral abscess •GI haemmorhage •Choledochoduodenal fistula •Pancreatic duct fistula •Perforation of peptic ulcer
- 20. Investigations For pneumoperitoneum: Erect x-ray chest – Gas bubble below diaphragm If patient can’t stand, take X-ray in lateral decubitus Best investigation is contrast enhanced CT which can detect gas bubbles missed by X-ray.
- 21. Treatment •Broad spectrum antibiotic therapy is initiated based on site of perforation •There is little role of conservative management except in patients with contained perforation, gastrointestinal fistula formation, or limited contamination as judged by imaging, in those who have no signs of systemic sepsis antibiotic therapy combined with drainage (effusion, abscess), provision for nutritional support (eg, gastrostomy, feeding jejunostomy), or stent placement may be an appropriate initial management strategy.
- 22. Surgical Management •The most common surgery performed for perforated peptic ulcer is oversewing the ulcer or the use of a Graham’s patch (healthy omentum) which is used because suturing of an inflamed ulcer can be difficult or impossible. Endoscopic gastric closure may be achieved via Natural Orifice Trasluminal Endoscopic Surgery technique.
- 23. Thank You