April 12, 2009

Acute onset abdominal pain in 72 years old male

A 72 years old, Malay male presented to Emergency room after developing severe abdominal pain 1 hour prior to admission. The pain is deep and burning in nature. He denied any history of sweating, nausea and vomiting.

He said that he has experienced the same pain since two years ago after taking medicine for oateoarthritis. However the pain is less severe and he can tolerate the pain compared to this time. Plain erect abdominal x ray was taken.

1) State two abnormality seen in this radiograph (2m)

2) State the most likely diagnosis (2m)

3) State one predisposing factor leading to the condition in this patient (1m)

4) List two relevant investigation for this patient (2m)

5) Outline the management for this patient (3m)



a) Bilateral gas under diaphragm

b) Double wall bowel loop/ visible outer layer of small intestine (Rigler signs)

2) Pneumoperitoneum secondary to perforated peptic ulcer

3) Non steroidal anti Inflammatory drugs for treating osteoarthritis.

4) Relevant investigation

a) Emergency laparotomy

b) Complete blood count

5) Management

- Gastric decompression

- IV fluid rehydration

- Broad spectrum antibiotic for prophylaxis

- Closure of perforated ulcer with omental patches.

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Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.