Patient is on autocoids for 1 year complains of severe pain epigasrium relieved iv antacids now complains of pain in right iliac fossa and epigastrium with fever and loss of liver dullness diagnosis -

Ans. is 'a' i.e., Duodenal perforation * Long term therapy with autocoids led to an ulcer that eventually perforated and now the patient has presented early signs of peritonitisClinical features of perforation of duodenal ulcer* Perforated duodenal ulcer is characterized by sever constant onset epogastric pain* Patient looks ill and lies unusually still* Tachycardia* Shallow respiration* Tender with intense guarding and rigidity* If the air has escaped into peritoneal cavity then liver dullness may be absent* Peptic ulcer perforation leads to chemical peritonitis initially. Thus in the first 24 hours, the patient does not show signs of general toxicity. After this period bacterial peritonitis sets in.