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.