HTHSCI 2F03 Lecture Notes - Lecture 5: Perforated Ulcer, Gastric Outlet Obstruction, Fluid Replacement
26 Dec 2020
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Late complication of pud fibrotic stricturing. Hx of bloating, early satiety and nausea. Copious projectile, non-bilious vomiting a few hrs after meals. Dilated gastric air bubble, air fluid level. Correct metabolic abnormality: 0. 9% ns + kcl. Test feed: palpate mass + see peristalsis. 1st part of the duodenum: highest acid conc. Post. perforation can erode into gda bleed. Of duodenum retroperitoneal no air under diaphragm if perforated. Sudden onset severe pain, beginning in the epigastrium and then becoming generalised. Air under the diaphragm seen in 70% Rigler"s: air on both sides of bowel wall. May be considered if pt. isn"t peritonitic. Omentum may seal perforation spontaneously preventing operation in ~50% Du: abdominal washout + omental patch repair. Partial / gastrectomy may rarely be required. 90% of perforated pu assoc. c h. pylori. Partial or total gastrectomy c roux-en-y to prevent bile reflux. Spleen and part of pancreas may be removed. Geo: in japan, eastern europe, china, s. america.
