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
**Core Concept**
The question tests the student's ability to diagnose a gastrointestinal emergency, specifically a perforation of the duodenum. This condition requires prompt recognition and surgical intervention to prevent complications such as peritonitis and sepsis.
**Why the Correct Answer is Right**
The patient's symptoms of severe epigastric pain relieved by IV antacids initially suggest a peptic ulcer disease. However, the subsequent development of pain in the right iliac fossa, fever, and loss of liver dullness on percussion are indicative of a perforated viscus. The duodenum, being a part of the upper gastrointestinal tract, is more susceptible to perforation due to its thin walls and proximity to the abdominal wall. The loss of liver dullness is a classic sign of free air under the diaphragm, which is often associated with a perforated viscus.
**Why Each Wrong Option is Incorrect**
**Option B:** Diverticulitis typically presents with left lower quadrant pain, fever, and changes in bowel habits, but it is less likely to cause free air under the diaphragm.
**Option C:** Gastroenteritis typically presents with symptoms such as diarrhea, vomiting, and abdominal cramps, but it is not typically associated with a perforation or loss of liver dullness.
**Option D:** Enteric perforation is a broader term that refers to a perforation of the small intestine, but it is not as specific as duodenal perforation, which is the likely diagnosis in this case.
**Clinical Pearl / High-Yield Fact**
The loss of liver dullness is a critical clinical sign that indicates the presence of free air under the diaphragm, which is often associated with a perforated viscus. This sign can be confirmed with an upright chest X-ray, which shows the presence of air under the diaphragm.
**✓ Correct Answer: A. Duodenal perforation**