Transcription of Management of perforated gastric and duodenal …
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Management of perforated gastric and duodenal …
Joyce Au SUNY Downstate Grand Rounds September 27, 2012 Management of perforated gastric and duodenal ulcers 97 F with 2 days of sudden, diffuse, constant abdominal pain with some lightheadedness No fevers/chills/N/V/diarrhea/bloody BM PMH/PSH: HTN, atrial fibrillation, s/p hysterectomy, right knee surgery, left breast surgery Meds: amlodipine, atenolol; no anticoagulation due to history of falls Soc hx: lives alone T= , HR=125, BP=106/77, RR=20 Alert, oriented, responsive Abdomen soft, mildly distended, very tender diffusely, + guarding and rebound tenderness, + bowel sounds; no mass on DRE, guaiac negative RRR, clear breath sounds b/l, no CVA tenderness, no pedal edema CBC: (91% PMN) / 12 / / 330 BMP: 137 / / 94 / 30 / 49 / / 82 UA negative Coags normal EKG atrial fibrillation with HR of 99 CXR large amount of free air CT - large amount of free air; no contrast extravasation; no obstruction OR findings Turbid fluid in the upper abdomen 5 m
Joyce Au . SUNY Downstate Grand Rounds . September 27, 2012 . Management of perforated gastric and duodenal ulcers www.downstatesurgery.org
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