🩹 Peptic Ulcer Perforation Simulator

Ulcer Erosion Through the Full Gastric Wall

Placeholder: acid and pepsin slowly erode through all wall layers.

• Duodenum: Common site (Placeholder short note)
• 4/4: Wall layers lost (Placeholder short note)
• H. pylori / NSAID: Main cause (Placeholder short note)
• Chronic: Onset (Placeholder short note)

Erosion mechanism

Placeholder: acid erodes mucosa, submucosa, muscularis, then serosa.

Placeholder: full-thickness breach opens the lumen to the peritoneal cavity.

Sudden Severe Abdominal Pain Onset

Placeholder: gastric contents spill and trigger sudden severe pain.

• Seconds: Pain onset (Placeholder short note)
• Sharp/knife-like: Pain type (Placeholder short note)
• Epigastric: Location (Placeholder short note)
• Shoulder tip: Radiation (Placeholder short note)

Chemical peritonitis

Placeholder: spilled gastric acid irritates the peritoneum instantly.

Placeholder: patients often recall the exact moment of onset.

Free Air Rises Under the Diaphragm

Placeholder: escaped gastric air collects under the diaphragm.

• Free air sign: Sign name (Placeholder short note)
• Erect CXR: Imaging (Placeholder short note)
• ~75%: Detection rate (Placeholder short note)
• Sub-diaphragm: Best view (Placeholder short note)

Radiographic free air

Placeholder: air rises to the highest point, under both hemidiaphragms.

Placeholder: absence of free air does not exclude perforation.

Rigid Abdomen — The Classic Triad

Placeholder: pain, rigidity, and tenderness define the triad.

• Sudden pain: Sign 1 (Placeholder short note)
• Board-like rigidity: Sign 2 (Placeholder short note)
• Rebound tenderness: Sign 3 (Placeholder short note)
• Absent: Bowel sounds (Placeholder short note)

Generalized peritonitis

Placeholder: diffuse peritoneal irritation causes guarding and silence.

Placeholder: delay raises sepsis and mortality risk sharply.

Emergency Graham Patch Repair

Placeholder: omentum is tacked over the perforation and sutured.

• Graham patch: Procedure (Placeholder short note)
• Omentum: Tissue used (Placeholder short note)
• Open/laparoscopic: Approach (Placeholder short note)
• <24h: Golden window (Placeholder short note)

Omental patch closure

Placeholder: sutures anchor a vascularized omental plug over the hole.

Placeholder: early repair strongly improves survival odds.