Peforated Peptic Ulcer
Peforated Peptic Ulcer
Peforated Peptic Ulcer
BY A.C MBULO.
PERFORATED PEPTIC ULCERS
(a) Draw a well labeled Diagram illustrating the sites of ulcers
Gastric ulcers lesser curvature , body, fundus, antrum.
Deodenal ulcers
Oesophageal ulcers 15%
(b) State five (5) clinical features of perforated peptic ulcers 15%
1.Severe upper abdominal pain throughout the abdomen transmitted by
the abundant visceral and parietal peritoneal pain receptors.
2.Shoulder pain due to stomach or deudenal spillage into peritoneal
cavity causing irritation to the phrenic nerve.
3.Rigid and tender abdominal muscles (quarding) as an attempt to protect
the abdomen from further injury
• The patient is nursed in acute bay in supine position with the head tilted
to one side to facilitate drainage of secretions until patient fully recovers
from anaesthesia and is propped up on pillows.
• I’ll observe patient for Dyspnoea which may indicate poor recovery and
respiratory distress.
• I’ll observe for Cyanosis of lips and extremeties indicate low oxygen
body content
• Rapid feeble pulse with a low blood pressure may indicate shock.
These vital signs are graduated to hourly, 2 hourly and 4 hourly as they
stabilize.
• I’ll also observe abdominal dressing for soiling which may indicate
internal haemorrhage
• I’ll also observe the patient for the Presence of abdominal distension
which is an indication of internal hemorrhage.
• I’ll administer the prescribed pain killers such as Pethidine IMI 100 mg 6 hourly x 3
doses is given. 2%
NUTRITION:
• I’ll keep the patient nil orally therefore I’ll commence 5% dextrose to supply
glucose nutrient and normal saline or Ringers lactate to replace lost electrolytes. Sips
of water may be started if bowel sounds present and abdomen is soft.
• To add on I’ll answer questions the patient is going to ask and refer
some questions to my colleague or the surgeon to answer .
• I’ll also reassure the patient and care taker to enhance co-operation to
treatment and care and relieve anxiety.
Hygiene
• On the 2nd day post-operative, bed bath is given and asisted oral toilet is
done.
1.Dumping syndrome:
• The feed should contain moderate amount of protein and fat. Fluids be
taken between meals but not with meals as this will quicken the
dumping of food into the small stomach.
2.Postprandial Hypoglycemia:
• Advise the patient to take a gluten free diet. Iron supplements are
also encouraged. Give 4% for each to make 16%.