Perforation

Perforation is heralded by the abrupt onset of severe epigastric pain as gastric or duodural contents spill into the peritoneal cavity, followed by the development of chemical and then bacterial peritonitis. Patients may not have a prior history of peptic ulcer disease and may in fact have no antecedent history of ulcer-like symptoms. Elderly patients may not have dramatic pain or impressive peritoneal findings.

When the diagnosis is suspected, appropriate laboratory tests, including a complete blood count, type and crossmatch, and a lipase level determination, should be performed; two large-bore intravenous lines started; oxygen and a monitor placed; a nasogastric tube inserted and placed on suction; and an acute abdominal series obtained. Free air is not always present. Some authorities suggest instillation of air into the stomach through the nasogastric tube in order to detect perforation. This procedure may open a sealed perforation, causing more spillage, and if free air is still not visualized, it does not rule out a perforation; thus, it is not recommended. Broad-spectrum antibiotics should be given and a surgical consult promptly obtained. In some cases, nonsurgical therapy has been successful, but operative intervention is the standard in the United States.

Spiritual Weight Loss Mentality

Spiritual Weight Loss Mentality

Awesome Ways To Get Over Your Mentality That Keeps you Overweight! This Book Is One Of The Most Valuable Resources In The World When It Comes To Results In Your Slim-down and Health Efforts! Day in day out we keep ourselves absorbed with those matters that matter the most to us. A lot of times, it might be just to survive and bring in some money. In doing so we at times disregard or forget about the extra matters that are essential to balance our lives. They’re even more essential to supply real meaning to our world. You have to pay attention to your wellness.

Get My Free Ebook


Post a comment