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Perforated ulcer of the stomach and duodenum
There are perforations of chronic and acute ulcers. Perforation can be typical - in the free abdominal cavity or atypical - covered, in an omental bursa, in retroperitoneal fiber.
There are 3 stages during a perforated ulcer.
· The stage of shock (the first 6 hours) is characterized by sharp pain in the epigastric region, which suddenly appeared as a “dagger strike”. Possible vomiting. Pale skin with cyanosis of the lips, cold sweat is noted. The breath is shallow. Bradycardia, possibly a decrease in blood pressure. The body temperature is normal. The abdomen is not involved in breathing, retracted. Palpation and percussion of the abdomen are sharply painful. On palpation - expressed muscle tension (abdomen "like a board"). Symptom Shchetkina — Blumberg positive. With percussion, hepatic dullness may disappear.
The stage of imaginary well-being (after 6 hours) is characterized by a decrease in abdominal pain, but symptoms of peritonitis and general intoxication increase: tachycardia, fever, dry tongue, bloating, stool and gas retention due to intestinal paresis. Percussion - signs of gas and fluid in the abdominal cavity; peristalsis is sluggish, the symptom of Shchetkin — Blumberg is positive.
· Stage of peritonitis (develops after 10-12 hours from the onset of the disease). Abdominal pain intensifies, the patient is disturbed by a feeling of bloating, gas exhaustion, body temperature rises, tachycardia increases. Symptoms of peritoneal irritation are sharply positive. Peristaltic noises are either attenuated or absent.
Symptoms with a covered perforated ulcer can occur suddenly (“dagger” pain, signs of collapse, shock, muscle tension in the anterior abdominal wall), however, as the ulcer is “covered” by the edge of the right lobe of the liver or by the lock of the greater omentum, all these signs may disappear.
More often, the clinical picture of sluggish peritonitis is observed. Perforation in the stuffing bag is not accompanied by a shock reaction, pain is much less intense than with the classical picture of perforation.
The zone of greatest pain with a possible infiltrate is localized in the epi- or mesogastric region. Symptoms of peritoneal irritation, as a rule, are not pronounced. When perforated into the retroperitoneal space, local and general signs of purulent inflammation quickly appear, in the first hours, localized subcutaneous emphysema may appear in the lumbar region on the right.
A perforated ulcer of the stomach and duodenum should be differentiated from acute appendicitis, acute cholecystitis, acute pancreatitis, acute intestinal obstruction, abscess of the abdominal cavity, mesenteric vascular embolism, hepatic colic, lead colic, as well as from inferior infarction of the myocardial infarction, pneumonia, and lobar infarction.
· Put the patient on a shield and a stretcher with a raised head end and legs bent at the knee and hip joints.
Cold on the stomach.
· Introduce a nasogastric tube to evacuate stomach contents.
· Intravenously inject 0.9% sodium chloride solution, 5% glucose solution, dextran [cf. pier weight 50,000 - 70,000] (polyglucin *) (total volume up to 1 liter).
· Emergency hospitalization in the surgical department.
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Perforated ulcer of the stomach and duodenum
- Perforated ulcer of the stomach and duodenum
Perforated (perforated) ulcer of the stomach or duodenum - the formation of an opening in the wall of the stomach or duodenum in a pre-existing ulcerative defect and the entry of gastrointestinal contents into the abdominal cavity. ETIOLOGY AND PATHOGENESIS A perforated ulcer is preceded by an exacerbation of a peptic ulcer or the development of an acute ulcer. Perforations contribute to: ¦ alcohol intake; ¦
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