Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. It is an abdominal catastrophe and requires immediate surgery
Penetration is erosion of the ulcer through the gastric serosa into adjacent structures such as the pancreas, biliary tract, or gastrohepatic omentum. What are the signs and symptoms of perforation? (Mark all that apply.)
A) Collapse
B) Hypertension
C) Pain referred to the right shoulder
D) Vomiting
E) Bradycardia
Ans: A, C, D
Feedback: Signs and symptoms of perforation include the following: sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (boardlike) abdomen; and hypotension and tachycardia, indicating shock.
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