Insidious

A 67 year old lady presents with severe, dull epigastric pain for 6 hours, which was almost instantaneous in onset. The pain is exacerbated by movement, does not radiate and is associated with mild nausea. No other symptoms are present.

Her medical history is only significant for well controlled hypertension for 10 years. She does not drink or smoke.

Select Relevant Investigations
Full Blood Count

Performed

WBC/DC: 3,400/mm3
N: 52%, L: 39%

Hb: 12.3 g/dl
PCV (Hct): 39%

Platelets: 185,000/mm3
ECG

Performed

Serial ECGs are obtained; all appear normal.
Contrast CT Abdomen

Performed

Free gas in the peritoneum and a small right subphrenic collection are seen. Addition of oral contrast shows a large ulcer in the gastric antrum, with no contrast leakage into the peritoneal cavity. The gallbladder, pancreas, abdominal aorta & mesenteric vein appear normal.
Urgent Barium Meal

Performed

The Barium Meal will be arranged tomorrow.

Select Relevant Management
Endoscopic therapy stat
NG Tube stat
IV Antibiotics stat
IV Pantoprazole stat