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.