Sandbox mk

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

• Peptic ulcer disease patient appears in severe stress due to severe abdominal pain.Common physical examination findings of peptic ulcer disease include epigastric tenderness, tachycardia.Perforated peptic ulcer disease patient presents with classic triad of severe epigastric tenderness, tachycardia, and abdominal rigidity
• Clinical signs of perforated peptic ulcer comes in 3 stages:
  • In the initial stage within first 2 hours, the patient presents with tachycardia, epigastric pain and cool extremities.
  • In next 2 to 12 hours, the patient presents with lower right quadrant tenderness and abdominal rigidity.
  • In more than 12 hours, the patient presents with abdominal distension, hypotension, and pyrexia with acute circulatory collapseChung KT, Shelat VG (2017). "Perforated peptic ulcer - an update". World J Gastrointest Surg. 9 (1): 1–12. doi:10.4240/wjgs.v9.i1.1. PMC 5237817. PMID 28138363.

Preferred Template Statements

• Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
• Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
• The presence of [finding(s)] on physical examination is diagnostic of [disease name].
• The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Appearance of the Patient

• Patient usually appear in severe distress due to severe abdominal pain.

Vital Signs

• Patient has normal vital signs in initial stages of peptic ulcer.
• In peptic ulcer perforations vital signs may include :Bertleff MJ, Lange JF (2010). "Perforated peptic ulcer disease: a review of history and treatment". Dig Surg. 27 (3): 161–9. doi:10.1159/000264653. PMID 20571260.
  • Tachycardia with regular pulse
  • Weak pulse
  • low blood pressure with normal pulse pressure
  • High-grade fever is present at later stage of peptic ulcer perforation

Skin

• Pallor is present in patients presents with hematemesis and melena.

• 

  By Dr Graham Beards (Own work)

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  The hand of a person with severe anemia (on the left) compared to one without (on the right)By James Heilman, MD - Own work

HEENT

• Pallor on the lower conjunctiva can be seen.

Neck

• Supple ,trachea is centrally placed and no lyphadenopathy

Lungs

• Normal B/L vesicular breath sounds.

Heart

• S1 and S2 normal ,no murmur/rubs/gallops.

Abdomen

• Abdominal tenderness at the epigastrium
• Perforated peptic ulcer Bertleff MJ, Lange JF (2010). "Perforated peptic ulcer disease: a review of history and treatment". Dig Surg. 27 (3): 161–9. doi:10.1159/000264653. PMID 20571260.
  • Rebound tenderness
  • Decreased bowel sounds

Back

• NO redness ,visible deformity ,no tenderness

Extremities

• Pallor can be seen on hand

Neuromuscular

• Patient is usually oriented to persons, place, and time

References

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