Lecture notes for medical students

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2. Introduction & History.

3. Introduction & History.
Uncommon complication of peptic ulcer.

4. Etiology

5. Etiology
• Idiopathic
• Congenital
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative

6. Etiology
• Peptic ulcer.
• Ca. Stomach

7. Pathophysiology

8. Pathophysiology
• Gastric secretions, cause chemical
peritonitis.
• outpouring of fluid from the peritoneal
membrane.
• Loss of fluid from the circulation
hypovolemic shock.
• Addition of bacteria produces suppuration
• The peritoneum reacts by pouring fluid and
intestine react by cessation of peristalsis.

9. Clinical Features

10. Clinical Features
• Demography
• Symptoms
• Signs
• Prognosis
• Complications

11. Demography

12. Demography
• Incidence of peptic ulcer has dropped but
incidence of perforated peptic ulcer has
increasing.

13. Symptoms

14. Symptoms
• Acute onset of abdominal pain. Often, they
can tell the exact time of the perforation.
• The pain starts in the epigastrium
generalized
• History of PUD NSAID Corticosteroid

15. Signs

16. Signs
• Shock
• Boardlike rigidity
• Tenderness
• Percussion – Obliterated liver dullness
• Absent bowel sounds
• Lucid interval

17. Prognosis

18. Prognosis
• Bad

19. Complications

20. Complications
• Shock Hypovolemic >Septic
• Intraabdominal Abscess
– subdiaphragmatic, subhepatic, paracolic, or
pelvic
• Pleural effusion
• Intraabdominal adhesions

21. Investigations

22. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histlogy

23. Diagnostic Studies

24. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

25. Gas under diaphragm

26. Chest Radiograph

27. Diagnostic Studies
Imaging Studies
• X-Ray- About 75% of patients have
pneumoperitoneum
• lateral decubitus radiograph
• Contrast upper GI series /CT
• Ultrasound is less sensitive for detecting
free air but could be used to identify other
indirect findings of perforation such as free
fluid and decreased peristalsis when the
diagnosis remains in question.

36. SP. Absc

38. Chiliaditi

39. Differential Diagnosis
• Myocardial infarction.
• Pancreatitis
• Enteric perforation
• Acute appendicitis – Valentino appendix
• Acute Cholecystitis

40. Management

41. Management
• Resuscitation
• Laparotomy with closure of perforation
• Laparoscopic approach
• Conservative

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45. Get this ppt in mobile
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46. Get this ppt in mobile

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