I.

INTRODUCTION

Perforated peptic ulcer is a common emergency condition worldwide, with

associated mortality rates of up to 30%. According to the latest WHO data published in
2017 Peptic Ulcer Diseases Deaths in Philippines reached 6,784 or 1.10% of total
deaths. The age adjusted Death Rate is 10.36 per 100,000 of population ranks
Philippines #8 in the world. A scarcity of high-quality studies about the condition limits
the knowledge base for clinical decision making, but a few published randomized trials
are available. Although Helicobacter pylori and use of non-steroidal anti-inflammatory
drugs are common causes, demographic differences in age, sex, perforation location,
and underlying causes exist between countries, and mortality rates also vary. Clinical
prediction rules are used, but accuracy varies with study population. Early surgery,
either by laparoscopic or open repair, and proper sepsis management are essential for
good outcome. Selected patients can be managed non-operatively or with novel
endoscopic approaches, but validation of such methods in trials is needed. Quality of
care, sepsis care bundles, and postoperative monitoring need further assessment.
Adequate trials with low risk of bias are urgently needed to provide better evidence. We
summarize the evidence for perforated peptic ulcer management and identify directions
for future clinical research.

Perforated peptic ulcer is a surgical emergency and is associated with short-term

mortality in up to 30% of patients and morbidity in up to 50%.1 Worldwide variations in
demography, socioeconomic status, Helicobacter pylori prevalence, and prescription
drugs make investigation into risk factors for perforated peptic ulcer difficult. Perforated
peptic ulcer presents as an acute abdominal condition, with localized or generalized
peritonitis and a high risk for development of sepsis and death.(WHO,2017)

Early diagnosis is essential, but clinical signs can be obscured in elderly people or
immunocompromised patients, thus delaying diagnosis. Imaging has an important role
in diagnosis, as does early resuscitation, including administration of antibiotics.
Appropriate risk assessment and selection of therapeutic alternatives becomes
important to address the risk for morbidity and mortality. In this review, we present an
update on the present understanding and management of perforated peptic ulcer.
(World Journal of /emergency Surgery 2018)

The person we’ve met in Pagamutan ng Dasmariñas last January 31, 2019, diagnosed
with Perforated Peptic Ulcer. We chose this case because this is one of the topic that
we’ve been discussed earlier in our major subject in Medical Surgical 2, also this is very
interesting for us to know and to be more knowledgeable about this case.
X. DISCHARGE PLAN: (METHODS)

Medication:

- Instructed patient to continue home medications as ordered by Dr. Rubrica such

as:
 Clopidiril 75mg 1 tab once a day at bed time, 7pm
 Ketoanalogue 600mg thrice a day 6am/12pm/6pm
 Trimetazidine 35mg 1 tab twice a day. 8am/8pm.

To Follow:

- Informed patient go to follow up check up on October 16, 2017 with Dr. Rubrica

Health Teaching

- Advised patient to maintain healthy lifestyle in doing eating healthy habit like
eating raw vegetable and fruits.
- Instructed the patient to change position when lying on bed to prevent bed sore.

Observe for:

- Advised the patient to report any untoward signs and symptoms like dizziness,
chest pain.

Diet:

- Advised patient to avoid high calorie food such as chicken skin, fats, fried food.
- Advised patient to avoid simple carbohydrates like cake,pastries, because it can
cause hyperglycemia.
- Instructed the patient to restrict the fluid intake. Drink not more than 1000ml of
water a day.
 - Advised patient to eat high fiber especially vegetables, cereals because fiber
inhibits glucose absorption.

Spiritual:

- Encourage patient to always pray and go to church every Sunday.