Perforated Pyloroduodenal Peptic Ulcer and Sonography

Thorsen

Journal of British Surgery

2014

184

Section: Resultsmentioning

confidence: 99%

Strategies to improve the outcome of emergency surgery for perforated peptic ulcer

Thorsen

Journal of British Surgery

2014

184

Cochrane Database of Systematic Reviews

“…Radiological findings of acute pancreatitis evolve over a few days, and the radiological examination may not demonstrate characteristic features in the early stages, or may even be normal (Banks 2013;Vissers 1999), thus radiological tests are not routinely performed for diagnosing this condition. In addition, acute pancreatitis can mimic perforated peptic ulcer (Kuzmich 2012), which is usually treated by surgery. Correct diagnosis of acute pancreatitis can avoid unnecessary surgery.…”

Section: Rationalementioning

confidence: 99%

Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis

Rompianesi

Hann

Komolafe

et al. 2017

As about a quarter of people with acute pancreatitis fail to be diagnosed as having acute pancreatitis with the evaluated tests, one should have a low threshold to admit the patient and treat them for acute pancreatitis if the symptoms are suggestive of acute pancreatitis, even if these tests are normal. About 1 in 10 patients without acute pancreatitis may be wrongly diagnosed as having acute pancreatitis with these tests, therefore it is important to consider other conditions that require urgent surgical intervention, such as perforated viscus, even if these tests are abnormal.The diagnostic performance of these tests decreases even further with the progression of time, and one should have an even lower threshold to perform additional investigations if the symptoms are suggestive of acute pancreatitis.

“…Certain medications, in particular nonsteroidal anti-inflammatory drugs and aspirin, are other leading causes (37). Peptic ulcer disease affects the duodenal bulb most frequently (35%-65% of cases), followed by the pylorus and distal gastric antrum (30%-45%) and gastric body (5%-15%) (39). When infectious gastritis or peptic ulcer disease is suspected clinically, patients first undergo noninvasive testing for H pylori and, if positive for infection, treatment with antibiotics is initiated.…”

Section: Gastritis and Peptic Ulcer Diseasementioning

confidence: 99%

“…Thickening of the gastric antrum beyond 4 mm suggests gastritis (38). When the stomach or duodenum is sufficiently distended with fluid, a peptic ulcer may be identified as a focal or linear echogenic region, with varying degrees of extension into the bowel wall (39,40). The presence of inflammatory changes, free fluid, or gas around the stomach or duodenum raises the possibility of perforation and can be confirmed at CT (38)(39)(40).…”

Section: Gastritis and Peptic Ulcer Diseasementioning

confidence: 99%

US of Right Upper Quadrant Pain in the Emergency Department: Diagnosing beyond Gallbladder and Biliary Disease

et al. 2018

Acute cholecystitis is the most common diagnosable cause for right upper quadrant abdominal (RUQ) pain in patients who present to the emergency department (ED). However, over one-third of patients initially thought to have acute cholecystitis actually have RUQ pain attributable to other causes. Ultrasonography (US) is the primary imaging modality of choice for initial imaging assessment and serves as a fast, cost-effective, and dynamic modality to provide a definitive diagnosis or a considerably narrowed list of differential possibilities. Multiple organ systems are included at standard RUQ US, and a variety of ultrasonographically diagnosable disease processes can be identified, including conditions of hepatic, pancreatic, adrenal, renal, gastrointestinal, vascular, and thoracic origin, all of which may result in RUQ pain. In certain cases, subsequent computed tomography, magnetic resonance (MR) imaging, MR cholangiopancreatography, or cholescintigraphy may be considered, depending on the clinical situation and US findings. Familiarity with the spectrum of disease processes outside of the gallbladder and biliary tree that may manifest with RUQ pain and recognition at US of these alternative conditions is pivotal for early diagnosis and appropriate management. Diagnosis at the time of initial US can reduce unnecessary imaging and its consequences, including excess cost, radiation exposure, nephrotoxic contrast medium use, and time to diagnosis, thereby translating into improved patient care and outcome. This article (a) reviews the causes of RUQ pain identifiable at US using an organ-system approach, (b) illustrates the US appearance of select conditions from each organ system with multimodality imaging correlates, and (c) discusses the relevant pathophysiology and treatment of these entities to aid in efficient direction of management. Online supplemental material is available for this article. RSNA, 2018.