After dinner, woman develops sudden-onset9 severe, generalized abdominal pain, and accompanied by deterioration in patient's condition. The abdomen exhibits a board-like rigidity and the patient is disinclined to move because of the pain. The classical presentation is due to
Acute cholecystitis
Acute appendicitis
Perforated peptic ulcer
Acute pancreatitis
(C) Perforated peptic ulcer # Clinical features Perforated peptic ulcer:> The classic presentation is instantly recognizable. The patient, who may have a history of peptic ulceration, develops sudden- onset, severe, generalized abdominal pain as a result of the irritant effect of gastric acid on the peritoneum.> Although the contents of an acid-producing stomach are relatively in bacterial load, bacterial peritonitis supervenes over a few hours, usually accompanied by a deterioration in the patient's condition.> Initially, the patient may be shocked with a tachycardia but a pyrexia is not usually observed until some hours after the event.> The abdomen exhibits a board-like rigidity and the patient is disinclined to move because of the pain.> The abdomen does not move with respiration.> Patients with this form of presentation need an operation, without which they will deteriorate with a septic peritonitis.
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