a 37 told alcoholic continuously drinking alcohol since 2days presented with sudden onset of abdominal pain since today morning,o/e vital are stable with no urine output since morning x-ray abdomen erect attached how will. u manage the. case

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Peptic ulcer disease with Perforation

Hydropneumoperitonium with peritonitis.

Air under diaphragm..perf

Gas under diaphragm ? Perforation. Correct dehydration receptacle I v twice day monitoring BP. And pulse palpate abdomen for tidily. If borderline rigidity ? Perforation. DNS. Ringerlactate iv. Monitor. Kidney function

It could be aute pancreatitis with paralytic ileus. Gas is seen under left dome of diaphragm, which has become prominent due to paralytics ileus. Treatment is conservative, IV fluid, Nasogastric aspiration, pentazocine (fortwin), PPI, antibiotics. Serum amylase, USG abd should be done apart from routine investigation.

Hollow viscous perforation catheterise the patient maintain urine output by proper hydration evaluate electrolytes give iv antibiotics ryle's tube for gastric aspiration Get all investigations like CBC kft ecg hbsag hcvab lft with pt blood sugar random serum lipase amylase done immediately

Advised to get LFT RFT Serum Amylase TLC DLC Serum Eletrolytes Start iv line Give inn Drotaverin and Inj Ondestron Rush in fluids

Gas under diaphragm Perforation of ulcer

Gastric perforation operated by surgeon

Gas Under Right Dome Perforation. Stabilise n Proceed for Emergency Lap.

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