Patient is on Autocoids for 1 year now complains of severe pain Epigastrium relieved by antacid drugs. He complaints of Right Iliac fossa pain and loss of liver dullness. Diagnosis is:
**Core Concept**
The patient's presentation of severe epigastric pain relieved by antacids, combined with right iliac fossa pain and loss of liver dullness, suggests a diagnosis related to gastrointestinal perforation. This condition involves a breach in the integrity of the gastrointestinal tract, leading to leakage of its contents into the abdominal cavity.
**Why the Correct Answer is Right**
The patient's symptoms are consistent with a perforation of the duodenum, which is a part of the small intestine located near the stomach. The duodenum is a common site for peptic ulcers, which can perforate and cause severe abdominal pain. The relief of pain with antacids suggests that the pain is related to acid production, further supporting the diagnosis of a peptic ulcer perforation. The loss of liver dullness on percussion indicates the presence of free air in the abdominal cavity, which is a classic sign of a perforated viscus.
**Why Each Wrong Option is Incorrect**
**Option A:** Diverticulitis is a condition characterized by inflammation of diverticula in the colon, which can cause abdominal pain and tenderness. However, it does not typically present with severe epigastric pain or loss of liver dullness.
**Option B:** Gastroenteritis is an inflammation of the stomach and intestines, usually caused by viral or bacterial infections. While it can cause abdominal pain, it does not typically lead to perforation or loss of liver dullness.
**Option D:** Enteric perforation refers to a perforation of any part of the gastrointestinal tract other than the stomach. While it is a possible diagnosis, the patient's symptoms and signs are more suggestive of a perforation of the duodenum.
**Clinical Pearl / High-Yield Fact**
In cases of suspected gastrointestinal perforation, it is essential to perform an upright chest X-ray to detect free air under the diaphragm, which is a classic sign of a perforated viscus. This can help differentiate between a duodenal and gastric perforation.
**✓ Correct Answer: A. Perforation of duodenum**