Re: (I was sick)USMLE + FUN 9
sackatdoc - 10-10-08 10:19

realy with pharyngitis you went so unwell?we are so happy we are together here again interacting.
perforated peptic ulcer will present on history with long standing retrosternal burning or chest pain relieved with antacids and H2 blockers,
clinical symptoms sudden onset epigastric pain with signs of acute abdomen elicited on examination.The presentation can be sometimes confusing as after the perforation the the bleed may track down the right paracolic gutter and mimic acute appendicitis with tenderness over right lower quadrant.
XRCHEST will show gas under diaphragm.stabilise circulation,
exploratory laprotomy for repairing the perf.

Re: (I was sick)USMLE + FUN 9
niusha - 10-10-08 12:27

yeah I was totally ill....I couldn't eat or even drink anything and had hoarsness and couldn't even speak..sorry Sdoc I know that the team work is very important to have an alive Forum, and if some one be passive the others also won't have any mood to continue.so I'll try to be active and I hope I never get sick again, so be happy now ok?.the answer will be here tomorrow.

Re: (I was sick)USMLE + FUN 9
sackatdoc - 10-10-08 12:51

really, how did that get so bad, did you go out in cold weather,any close contacts with similar history,i'm still in my clinical skill exam mode i guess, yeah really happy to see your posts, take good care okay!!

Re: (I was sick)USMLE + FUN 9
niusha - 10-11-08 11:47

yeah..unfurtunately in Intern's Rest Room in hospital some of interns had this before..may be It has been contagouse...OK I will take care of myself since now..promis!
the answer:
Perforated peptic ulcer begins with SUDDEN(it's very important) abdominal pain in a Pt who has not gallstone neighter is alcoholic(risk factors for pancratitis) in a patient who has past medical history of peptic ulcer disease.In CXR u will see the air under the diapheragm.Remeber that Amylase will increase in Perforated PUD.
Sdoc your answer was compeletly correct.

Re: (I was sick)USMLE + FUN 9
sackatdoc - 10-11-08 14:02

thanks,niusha,you are indeed great, youre helping us in the review coz all the things you are asking are very important, thanks and take care

Re: (I was sick)USMLE + FUN 9
niusha - 10-17-08 01:08

come on boy, You are so professional and skillfull ,wish you luck...

Re: (I was sick)USMLE + FUN 9
ammulufy - 06-24-10 02:11

Hi guys.....I wud jst like to make sme minor modifications n enlighten u a little more......sudden in onset,severe abdominal pain usually epigastric though not mandatory......its more diagnosed based on signs like.....decreased respiratory movements on exmn;generalised board-like rigidity of the abdomen;reduced or complete absent bowel sounds;history of PUD;classic history may not b present if adhesions hav formed or d sme perforation has been close.......as of the invstigation part.....ac.pancreatitis shud b ruled out as immediately as possible lest it proves detrimental....through serum amylase estimation n confirmed further thru CT scan......n d final leg consists of LAPAROSCOPY trial to know d exact site of perforation...wch if fails can go to EXPLORATORY LAPOROTOMY......hope this info will definitely help u out guys.....JST WANNA MAKE DIS SITE REALLY FRUITFUL FOR ALL THE USMLE ASPIRANTS....