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Old 03-27-2014
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Default tx of perforated peptic ulcer

can anyone please explain this to me , why in perforated peptic ulcer mx we do surgeryimmediately as said in uworld while in MTB 3 it said nothing per oral first ???

uworld question is 4462
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Old 03-27-2014
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perforation of peptic ulcer leads to specific diagnostic finding of peumoperitonem which is seen as air under left dome of diaphragm,if u will not surgically repair that hole or defect contents will leak and cause chemical peritonitis which is very dangerous condition.if you do npo it will not help much patient from leaking of already present contents.
NPO is must for treatment of complete or partial bowel obstrction to give rest to bowel but not for perforation.
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Old 03-27-2014
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Quote:
Originally Posted by digoxin2013 View Post
perforation of peptic ulcer leads to specific diagnostic finding of peumoperitonem which is seen as air under left dome of diaphragm,if u will not surgically repair that hole or defect contents will leak and cause chemical peritonitis which is very dangerous condition.if you do npo it will not help much patient from leaking of already present contents.
NPO is must for treatment of complete or partial bowel obstrction to give rest to bowel but not for perforation.
i agree
but add one thing air under the left dome can be the normal presentation in case of air filled fundus of the stomach
air under the right dome is pathologic-between diaphragm and liver
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Old 03-27-2014
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sorry it was typo error.
thanks for correction
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Old 03-27-2014
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Originally Posted by hydrocephalus View Post
can anyone please explain this to me , why in perforated peptic ulcer mx we do surgeryimmediately as said in uworld while in MTB 3 it said nothing per oral first ???

uworld question is 4462
I think MTB 3 is just being a bit more pedantic. If given the choice as to what the next step was, NPO or surgery, I guess NPO would need to be the right answer, as any oral intake is contraindicated in a patient who is about to go for emergency surgery. NPO isnt so much a treatment as just something that needs to happen as part of the management of someone needing an emergent operation.

Would be a hard call knowing which one to answer if you were actually given this choice though...
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