Gastrointestinal System Disorders Q 76 - Gyan Darpan : Learning Portal
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Friday 15 April 2022

Gastrointestinal System Disorders Q 76

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid-epigastric area along with a rigid, board-like abdomen. These clinical manifestations most likely indicate which of the following?
    A. An intestinal obstruction has developed.
    B. Additional ulcers have developed.
    C. The esophagus has become inflamed.
    D. The ulcer has perforated.

Correct Answer: D. The ulcer has perforated.

The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike muscle rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. These patients may also demonstrate signs and symptoms of septic shock, such as tachycardia, hypotension, and anuria.

Option A: An intestinal obstruction would not cause mid-epigastric pain. Patients with perforated peptic ulcer disease usually present with a sudden onset of severe, sharp abdominal pain. Most patients describe generalized pain; a few present with severe epigastric pain. As even slight movement can tremendously worsen their pain, these patients assume a fetal position.
Option B: The development of additional ulcers would not cause a rigid, boardlike abdomen. Abdominal examination in a perforated ulcer usually discloses generalized tenderness, rebound tenderness, guarding, and rigidity.
Option C: Esophageal inflammation would not cause a rigid, boardlike abdomen. The degree of peritoneal findings is strongly influenced by a number of factors, including the size of the perforation, amount of bacterial and gastric contents contaminating the abdominal cavity, time between perforation and presentation, and spontaneous sealing of perforation.

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