Perforated ulcer

Perforated Ulcer
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Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Sudden severe abdominal pain, fever, nausea, vomiting
Complications	Peritonitis, Sepsis, Shock
Onset	Sudden
Duration	Acute
Types	N/A
Causes	Peptic ulcer disease, NSAIDs, Helicobacter pylori infection
Risks	Smoking, alcohol use, stress
Diagnosis	X-ray, CT scan, Endoscopy
Differential diagnosis	N/A
Prevention	N/A
Treatment	Surgical repair, antibiotics, proton pump inhibitors
Medication	N/A
Prognosis	Variable, depends on promptness of treatment
Frequency	N/A
Deaths	N/A

A perforated ulcer is a serious medical condition where an untreated peptic ulcer leads to a hole in the wall of the stomach or duodenum. This condition is a surgical emergency and can lead to severe complications if not treated promptly.

Pathophysiology

A perforated ulcer occurs when an ulcer erodes through the full thickness of the stomach or duodenal wall, creating an opening into the peritoneal cavity. This allows gastric contents to leak into the abdominal cavity, leading to peritonitis, an inflammation of the peritoneum. The presence of gastric acid and digestive enzymes in the peritoneal cavity can cause severe irritation and infection.

Causes

The primary causes of perforated ulcers include:

• Helicobacter pylori infection: This bacterium is a major cause of peptic ulcers and can lead to perforation if the ulcer is not treated.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications can irritate the stomach lining and contribute to ulcer formation and perforation.
• Excessive alcohol consumption and smoking: Both can exacerbate ulcer formation and increase the risk of perforation.

Symptoms

The symptoms of a perforated ulcer are typically sudden and severe, including:

• Sudden, intense abdominal pain
• Fever
• Nausea and vomiting
• Rigid, board-like abdomen
• Signs of shock, such as rapid heartbeat and low blood pressure

Diagnosis

Diagnosis of a perforated ulcer is based on clinical presentation and imaging studies. An X-ray may show free air under the diaphragm, indicating perforation. A CT scan can provide more detailed information about the location and extent of the perforation. Endoscopy may be used to visualize the ulcer directly.

Treatment

Treatment of a perforated ulcer typically involves emergency surgery to close the perforation and clean the peritoneal cavity. Antibiotics are administered to treat or prevent infection. Proton pump inhibitors are used to reduce gastric acid production and promote healing of the ulcer.

Prognosis

The prognosis for a perforated ulcer depends on the promptness of treatment. Early surgical intervention and appropriate medical management can lead to a good outcome, but delays in treatment can result in serious complications such as sepsis and shock.

Also see

• Peptic ulcer disease
• Helicobacter pylori
• Peritonitis
• Gastroenterology