Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Peptic Ulcer

Evaluate breaches in the standard of care to determine if there was a Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Peptic Ulcer

Answer the following questions to find out if the standard of care was followed for your case.

  • Were the symptoms of peptic ulcer elicited from the patient?
    Yes
    No
    Answer unknown
    Why is this important?
    Acute peptic ulcer patients present typically with a burning pain in the epigastric region of an acute onset associated with nausea and vomiting.
    (2011) 38 EPCCOP 3 383-394

  • Was a detailed medical history regarding any of the following obtained? Why is this important?
    Answer this question
    The symptoms such as blood in stools, vomiting of blood, anemia, severe abdominal pain and history of weight loss help the physician to determine the need for urgent intervention. “Alarm” signs and symptoms include
    • Weight loss
    • Dysphagia
    • Recurrent vomiting
    • Hematemesis and melena
    • Anemia
    • Epigastric mass

    (2011) 38 EPCCOP 3 383-394

  • Did the clinician evaluate the patient’s vital signs? Why is this important?
    Answer this question
    Patients who develop complications such as bleeding or ulcer rupture present in shock; with increased heart rate and decreased blood pressure. It is necessary for them to be resuscitated and undergo prompt endoscopy. Prompt resuscitation is the cornerstone in management of acute upper gastrointestinal bleeding.
    (2009) 37 EMEDIC 1 35-41

  • Was a thorough physical exam performed? Why is this important?
    Answer this question
    Increased pain in the epigastric region on abdominal examination is a common finding in patients with peptic ulcer disease
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  • Which of the following did the clinician observe? Why is this important?
    Answer this question
    Abdominal tenderness and rigidity are hallmarks of enteric perforation
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  • Which of the following imaging studies was performed? Why is this important?
    Answer this question
    Although an erect chest X-ray is performed initially in cases where perforation is suspected, it may not depict free air, and so computed tomography (CT) is the gold-standard investigation if diagnostic uncertainty persists.
    (2010) 28 ESURGO 11 549

  • Was the patient referred to a surgical gastroenterologist? Why is this important?
    Answer this question
    In case of acute peptic ulcer, surgical consult is mandatory for diagnostic procedures and therapeutic interventions.
    (1996) 76 ESRCNA 1 83-103

  • Which of the following procedures were performed? Why is this important?
    Answer this question
    In contemporary practice, barium radiography is mainly performed on patients who cannot undergo endoscopy.
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