(C) Perforated peptic ulcer # Clinical features Perforated peptic ulcer:> The classic presentation is instantly recognizable. The patient, who may have a history of peptic ulceration, develops sudden- onset, severe, generalized abdominal pain as a result of the irritant effect of gastric acid on the peritoneum.> Although the contents of an acid-producing stomach are relatively in bacterial load, bacterial peritonitis supervenes over a few hours, usually accompanied by a deterioration in the patient's condition.> Initially, the patient may be shocked with a tachycardia but a pyrexia is not usually observed until some hours after the event.> The abdomen exhibits a board-like rigidity and the patient is disinclined to move because of the pain.> The abdomen does not move with respiration.> Patients with this form of presentation need an operation, without which they will deteriorate with a septic peritonitis.