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GENERAL EXAMINATION
A.General Appearance
1.Built Moderate
2.Pallor Absent
3.Dehydration Severe
4.Eyes Sunken
5.Tongue Pink
6.Teeth Normal
VITAL DATA
1.Pulse 98 /min Regular
2.Temparature Normal
3.Respiration 31 /min
4.B.P. 15/90 mmHg
B.Abdominal examination
INSPECTION
a)Shape of abdomen Distended
b)Movement of abdominal wall with respiration Restricetd in the upper part
c)Hernia sites Normal
PALPATION
a)Tenderness All over the abdomen
b)Gaurding All over the abdomen
c)Muscular rigidity In epigastrium.rt.hypochondrium
d)Rebound tenderness Present
PERCUSSION
1.Liver dullness Obliterated
2.Shifting dullness Present
AUSCULTATION
1.Bowel sounds Sluggish
SYSTEMIC EXAMINATION
a)Heart S 1 S 2 Heart normal
b)Lungs Clinically clear
c)CNS No neurological deficit
d)Spine normal
e)Scrotum normal
PROVISIONAL DIAGNOSISPeritonitis due to duodenal ulcer perforation
INVESTIGATIONS
1.Urine
a)Albumin Trace
b)Sugar Nil
2.Hb% 76%
3.Blood urea 18 mg
4.Blood sugar 90 mg Random
5.Blood group AB + ve
6.Plain X-ray abdomen erect posture Gas under diaphragm
No 3852 Date 12/1/2008
TREATMENT
1.Preoperative
a)Nothing by mouth
b)Ryel's tube aspiration
c)Intravenous fluids
d)I.V.Antibiotics
e)No enema
2.Anaesthesia General Endo Tracheal
3.Operation text
a)Incision Upper mid line Laporotomy
b)Findings
1.Exudate 800 ml of frank pus
2.Perforation In anterior wall of First part of Duodenum
Size 3 mm Shape Round
PROCEDURE
Perforation is closed with 3 simple intermittent 2-0 silk sutures and reinforced
with omental patch.Peritoneal toilet done with normal saline .Compleete
haemostasis secureWound closed in layers after keeping in flanks
bilateral abdominal drains.
POST OPERATIVE PERIOD Uneventful
Naso Gasric aspiration,antibiotics,analgesics,and I V Fluids
Recovery from Paralytic Ileu 48 Hrs
Drains removed 5 th day
COMPLICATIONS
Post operative fever Nil
Wound infection Nil
Post operative vomitings Nil
Suture removal 10 th post operative day
Discharged on 13 th post operative day
Hospital stay 12 days
Interval between onset of symptoms and surgery Eleven hours
Follow up Followed up for one and half yrs,and patient was problem free
CASE NO.-2
A.General Appearance
1.Built Moderate
2.Pallor No
3.Dehydration Severe
4.Eyes Sunken
5.Tongue Dry & pink
6.Teeth Normal
VITAL DATA
1.Pulse 110 mm Regular
2.Temparature Normal
3.Respiration 32 / min
4.B.P. 150 /90
B.Abdominal examination
INSPECTION
a)Shape of abdomen Distended
b)Movement of abdominal wall with respiration Normal
c)Hernia sites Normal
PALPATION
a)Tenderness All over abdomen
b)Gaurding All over abdomen
c)Muscular rigidity Rt.Hypochondrium
d)Rebound tenderness Present
PERCUSSION
1.Liver dullness Obliterated
2.Shifting dullness Present
AUSCULTATION
1.Bowel sounds Sluggish
SYSTEMIC EXAMINATION
a)Heart Normal
b)Lungs clinically clear
c)CNS Normal
d)Spine NAD
e)Scrotum Normal
PROVISIONAL DIAGNOSISAcute perforation of Duodenal ulcer with Peritonitis
INVESTIGATIONS
1.Urine
a)Albumin Nil
b)Sugar Nil
2.Hb% 78%
3.Blood urea 24 mg
4.Blood sugar 86 mg
5.Blood group O +ve
6.Plain X-ray abdomen erect posture Gas under diaphragm
No. 4217 Date 18/1/08
TREATMENT
1.Preoperative
a)Nothing by mouth
b)Ryel's tube aspiration
c)Intravenous fluids
d)I.V.Antibiotics
e)No enema
2.Anaesthesia General Endo Tracheal
3.Operation text
a)Incision Upper Mid line Laporatomy
b)Findings
1.ExudateOne Litre bile stained fluid in peritoneal cavity
2.Perforation 0.5 cm size oval shaped in anterior wall of first part of
duodenum.
PROCEDURE
Simple closure of perforation with omental patch of Graham method with 2-0
Mersilk sutures.Peritoneal toilet done ,compleete haemostasis secured.
Wound closed in layers after keeping bilateral abdominal drains
in flanks
POST OPERATIVE PERIOD
Naso gastric Aspiration,Antibiotics,Analgesics,and IV Fluids
anti emetics
CASE NO.-3
PERSONAL HISTORY
1.Appetite Normal
2.Diet Vegetarian with plenty of chillies
3.Micturition Normal
4.Bowels Normal
5.Sleep Normal
6.Addictions
a)alcoholism 500 ml country liquor for 25 yrs
b)smoking 5 chuttas daily
c)chewing tobacco No
FAMILY HISTORY Nil particular
TREATMENT HISTORY Antacids and Rantac tabs for past 3 yrs.
GENERAL EXAMINATION
A.General Appearance
1.Built Thin
2.Pallor No
3.Dehydration Severe
4.Eyes Sunken
5.Tongue Dry & pink
6.Teeth normal
VITAL DATA
1.Pulse 90 min
2.Temparature Normal
3.Respiration 22 /min
4.B.P. 110 /60 mmHg
B.Abdominal examination
INSPECTION
a)Shape of abdomen Distended
b)Movement of abdominal wall with respiration Restricted
c)Hernia sites Normal
PALPATION
a)Tenderness Diffuse tenderness all over abdomen
b)Gaurding All over abdomen
c)Muscular rigidity All over abdomen
d)Rebound tenderness Present
PERCUSSION
1.Liver dullness Obliterated
2.Shifting dullness Present
AUSCULTATION
1.Bowel sounds Absent
SYSTEMIC EXAMINATION
a)Heart Normal
b)Lungs Cl.Clear
c)CNS Normal
d)Spine Normal
e)Scrotum Normal
PROVISIONAL DIAGNOSISPeritonitis due to duodenal ulcer Perforation
INVESTIGATIONS
1.Urine
a)Albumin Nil
b)Sugar Nil
2.Hb% 76%
3.Blood urea 24 mg
4.Blood sugar 146 mg
5.Blood group AB +ve
6.Plain X-ray abdomen erect posture Gas under diaphragm
No. 2461 Date 21/2/08
TREATMENT
1.Preoperative
a)Nothing by mouth
b)Ryel's tube aspiration
c)Intravenous fluids
d)I.V.Antibiotics
e)No enema
2.Anaesthesia General Endo Tracheal
3.Operation text
a)Incision Upper Midline Laporatomy
b)Findings
1.Exudate2 Litres of yellowish green fluid
2.Perforation 4 mm Size perforation on the anterior wall of first part of
duodenum
PROCEDURE
Perforation closed by Graham's omental patch using 2-0 silk sutures.Peritoneal
toilet done with 2 litres of normal saline.After securing haemostasis wound
closed in layers after keeping abdominal drains in both the flanks
POST OPERATIVE PERIOD
Naso gastric Aspiration,Antibiotics,Analgesics,and IV Fluids
cs for 15 yrs
es.Peritoneal
one month
mptomatic
CASE NO.-4
GENERAL EXAMINATION
COMPLICATIONS
Post operative fever Present
Wound infection No
Post operative vomitings No
Suture removal Alternate sutures on 7 th day,remaining on 9 th post operaive
Discharged on 10 th post op day
Hospital stay 10 days
Interval between onset of symptoms and surger Five and half days
Follow up For one and half yrs,without complications
s secured.
post operaive
CASE NO.-5
GENERAL EXAMINATION
A.General Appearance
1.Built Average
2.Pallor No
3.Dehydration Severe
4.Eyes Sunken
5.Tongue Dry & pink
6.Teeth Normal
VITAL DATA
1.Pulse 100 min Regular
2.Temparature Normal
3.Respiration 34 /min
4.B.P. 110 /90
B.Abdominal examination
INSPECTION
a)Shape of abdomen Distension of abdomen present
b)Movement of abdominal wall with respiration Less in upper abdomen
c)Hernia sites Normal
PALPATION
a)Tenderness In all quardrants
b)Gaurding Rt Hypochondrium
c)Muscular rigidity Rt.Iliac fossa
d)Rebound tenderness Present
PERCUSSION
1.Liver dullness Obliterated
2.Shifting dullness Present
AUSCULTATION
1.Bowel sounds absent
SYSTEMIC EXAMINATION
a)Heart Normal
b)Lungs Cl.Clear
c)CNS Normal
d)Spine Normal
e)Scrotum Normal
PROVISIONAL DIAGNOSISAcute Duodenal ulcer Perforation with Peritonitis
INVESTIGATIONS
1.Urine
a)Albumin Trace
b)Sugar Nil
2.Hb% 80%
3.Blood urea 28 mg
4.Blood sugar 72 mg
5.Blood group A + ve
6.Plain X-ray abdomen erect posture Gas under dome of Diaphragm
No. 1062 Date 5/3/2008
TREATMENT
1.Preoperative
a)Nothing by mouth
b)Ryel's tube aspiration
c)Intravenous fluids
d)I.V.Antibiotics
e)No enema
2.Anaesthesia General Endo Tracheal
3.Operation text
a)Incision Upper Midline Laporatomy
b)Findings
1.Exudate 2 Litres of purulent bile stained fluid
2.Perforation 5 mm Size perforation on the anterior wall of 1 st part of
Doudenum
PROCEDURE
Simple closure of perforation with 2-0 silk,with omental patch.Peritoneal toilet done
with 2 litres of normal saline,Wound closed in layers after keeping bilateral flank
drains.
POST OPERATIVE PERIOD
NasoGastric aspiration,Antibiotics,IV Fluids
COMPLICATIONS
Post operative fever No
Wound infection Present,Pus for C/S,E.Coli grown, sensitive to ciprofloxacin
Post operative vomitings No
Suture removal 9 th post op day,wound gaping closed by secondary suturing
Discharged on 11/4/2008
Hospital stay 34 days
Interval between onset of symptoms and surgery 82 hrs
Follow up Monthly follow up for six months ,with no problems,lost for further follow up
toilet done
her follow up
CASE NO.-6
GENERAL EXAMINATION
PROCEDURE
Simple closure of perforation with 2-0 silk,with omental patch.Peritoneal toilet done
with 2 litres of normal saline,Wound closed in layers after keeping bilateral flank
drains.
POST OPERATIVE PERIODUneventful
PROCEDURE
Simple closure of perforation with 2-0 silk,with omental patch.Peritoneal toilet done
with 2 litres of normal saline,Wound closed in layers after keeping bilateral flank
drains.
POST OPERATIVE PERIOD
GENERAL EXAMINATION
PROCEDURE
Simple closure of perforation with 2-0 silk,with omental patch.Peritoneal toilet done
with 2 litres of normal saline,Wound closed in layers after keeping bilateral flank
drains.
POST OPERATIVE PERIOD
Uneventful
NasoGastric aspiration,Antibiotics,IV Fluids
GENERAL EXAMINATION
A.General Appearance
1.Built Moderate
2.Pallor Absent
3.Dehydration Severe
4.Eyes Sunken
5.Tongue Dry ,coated
6.Teeth normal
VITAL DATA
1.Pulse 120/min feeble
2.Temparature Normal
3.Respiration 24/min
4.B.P. 90/60
B.Abdominal examination
INSPECTION
a)Shape of abdom Flat
b)Movement of abdominal wall with respiration restricted
c)Hernia sites Normal
PALPATION
a)Tenderness All over abdomen
b)Gaurding present
c)Muscular rigidity present
d)Rebound tendern Present
PERCUSSION
1.Liver dullness Obliterated
2.Shifting dullness Present
AUSCULTATION
1.Bowel sounds Absent
SYSTEMIC EXAMINATION
a)Heart Normal
b)Lungs Normal
c)CNS Normal
d)Spine Normal
e)Scrotu Normal
PROVISIONAL DIAGNOSISAcute Perforation of Duodenal ulcer with Peritonitis
INVESTIGATIONS
1.Urine
albumin 2+
b)Sugar Nil
2.Hb% 70%
3.Blood urea 40 mg
4.Blood sugar 78 mg
5.Blood group O +ve
6.Plain X-ray abdomen erect posture free air under diaphragm
No. 3161 Date 10/7/2008
TREATMENT
1.Preoperative
a)Nothing by mouth
b)Ryel's tube aspiration
c)Intravenous fluids
d)I.V.Antibiotics
e)No enema
2.Anaesthesia General Endo Tracheal
3.Operation text
a)Incision Upper Midline Laporatomy
b)Findings
1.Exudate3 litres straw colored fluid
2.Perforation 3 mm Size round shaped on anterior surface of 1 st part of
Duodenum
PROCEDURE
Simple closure of perforation with 2-0 silk,with omental patch.Peritoneal toilet done
with 2 litres of normal saline,Wound closed in layers after keeping bilateral flank
drains.
GENERAL EXAMINATION
A.General Appearance
1.Built Thin
2.Pallor absent
3.Dehydration present
4.Eyes sunken
5.Tongue dry pink
6.Teeth Normal
VITAL DATA
1.Pulse 100/min,low vol.
2.Temparature Normal
3.Respiration 20/min
4.B.P. 120/80
B.Abdominal examination
INSPECTION
a)Shape of abdomen Distended
b)Movement of abdominal wall with respiration restricted in upper abdomen
c)Hernia sites Normal
PALPATION
a)Tenderness Diffuse
b)Gaurding Rt.Hypochondrium,epigastrium,Rt.iliac fossa
c)Muscular rigidity Rt.Hypochondrium,epigastrium,Rt.iliac fossa
d)Rebound tenderness Present
PERCUSSION
1.Liver dullness Obliterated
2.Shifting dullness Present
AUSCULTATION
1.Bowel sounds Sluggish
SYSTEMIC EXAMINATION
a)Heart Normal
b)Lungs Normal
c)CNS Normal
d)Spine Normal
e)Scrotu Normal
PROVISIONAL DIAGNOSISAcute Perforation of Duodenal ulcer with Peritonitis
INVESTIGATIONS
1.Urine
a)Albumin
b)Sugar
2.Hb%
3.Blood urea
4.Blood sugar
5.Blood group
6.Plain X-ray abdomen erect posture free air under diaphragm
No. 5765 Date 7/8/2008
TREATMENT
1.Preoperative
a)Nothing by mouth
b)Ryel's tube aspiration
c)Intravenous fluids
d)I.V.Antibiotics
e)No enema
2.Anaesthesia General Endo Tracheal
3.Operation text
a)Incision Upper Midline Laporatomy
b)Findings
1.Exudate4 litres of yellowish green fluid present
2.Perforation 1 cm Size on anterior surface of 1 st part of Duodenum
PROCEDURE
Simple closure of perforation with 2-0 silk,with omental patch.Peritoneal toilet done
with 2 litres of normal saline,Wound closed in layers after keeping bilateral flank
drains.
GENERAL EXAMINATION
A.General Appearance
1.Built Moderate
2.Pallor No
3.Dehydration Severe
4.Eyes sunken
5.Tongue dry pink
6.Teeth Normal
VITAL DATA
1.Pulse 102 /min Regular
2.Temparature Normal
3.Respiration 24 /min
4.B.P. 110/80 mmHg
B.Abdominal examination
INSPECTION
a)Shape of abdom Flat
b)Movement of abdominal wall with respiration Diminished in upper part
c)Hernia sites Normal
PALPATION
a)Tenderness Diffuse
b)Gaurding Rt.hypochondrium,epigastrium
c)Muscular rigidity Absent
d)Rebound tenderness Rt.iliac fossa
PERCUSSION
1.Liver dullness Obliterated
2.Shifting dullness Present
AUSCULTATION
1.Bowel sounds Present
SYSTEMIC EXAMINATION
a)Heart Normal
b)Lungs Normal
c)CNS Normal
d)Spine Normal
e)Scrotu Normal
PROVISIONAL DIAGNOSIS Acute Perforation of Duodenal ulcer with Peritonitis
INVESTIGATIONS
1.Urine
a)Albumintrace
b)Sugar nil
2.Hb% 76%
3.Blood urea 50 mg
4.Blood sugar 68 mg
5.Blood group O +ve
6.Plain X-ray abdomen erect posture free air under diaphragm
No. 3679 Date 10/8/2008
TREATMENT
1.Preoperative
a)Nothing by mouth
b)Ryel's tube aspiration
c)Intravenous fluids
d)I.V.Antibiotics
e)No enema
2.Anaesthesia General Endo Tracheal
3.Operation text
a)Incision Upper Midline Laporatomy
b)Findings
1.Exudate300 ml of purulent fluid in peritoneum
2.Perforation 3 mm Size round shaped anterior aspect of 1 st part of Duodenum
PROCEDURE
Simple closure of perforation with 2-0 silk,with omental patch.Peritoneal toilet done
with 2 litres of normal saline,Wound closed in layers after keeping bilateral flank
drains.
toilet done
CASE NO.-12
GENERAL EXAMINATION
A.General Appearance
1.Built Moderate
2.Pallor No
3.Dehydration Present
4.Eyes Sunken
5.Tongue Dry pink
6.Teeth Normal
VITAL DATA
1.Pulse 80 /min regular
2.Temparature Normal
3.Respiration 34 /min
4.B.P. 140/90 mmHg
B.Abdominal examination
INSPECTION
a)Shape of abdom Distended
b)Movement of abdominal wall with respiration restricted in upper abdomen
c)Hernia sites Normal
PALPATION
a)Tenderness Diffuse
b)Gaurding Rt.hypochondrium
c)Muscular rigidity Present
d)Rebound tenderness Present
PERCUSSION
1.Liver dullness Obliterated
2.Shifting dullness Present
AUSCULTATION
1.Bowel sounds Sluggish
SYSTEMIC EXAMINATION
a)Heart Normal
b)Lungs Normal
c)CNS Normal
d)Spine Normal
e)Scrotu Normal
PROVISIONAL DIAGNOSISAcute Perforation of Duodenal ulcer with Peritonitis
INVESTIGATIONS
1.Urine
a)Albuminnil
b)Sugar nil
2.Hb% 70%
3.Blood urea 30 mg
4.Blood sugar 100 mg
5.Blood group B +ve
6.Plain X-ray abdomen erect posture free air under diaphragm
No. 7327 Date 16/12/08
TREATMENT
1.Preoperative
a)Nothing by mouth
b)Ryel's tube aspiration
c)Intravenous fluids
d)I.V.Antibiotics
e)No enema
2.Anaesthesia General Endo Tracheal
3.Operation text
a)Incision Upper Midline Laporatomy
b)Findings
1.Exudate4 litres of greenish brown moderately turbid ,fibrinous flakes over intestines
2.Perforation 4 mm Size,circular shape anterior aspect 1st part of duodenum
PROCEDURE
Simple closure of perforation with 2-0 silk,with omental patch.Peritoneal toilet done
with 2 litres of normal saline,Wound closed in layers after keeping bilateral flank
drains.