Continued
This case is predisposed by

Treatment is

45 y old man came to ER with severe upper abdominal pain , he has history of smoking& recurrent attack of heart burn , on examination he had
Very rigid abdomen
Obliteration liver dullness You must suspect

Continued
The patient had a slight improvement of the pain & he want to back to home
This stage is called

Continued
In this case which intervention is contraindicated

Obliterated liver dullness is because of

Continued

If Investigation deont that perforation was in a stomach, you should exclude

The patient was prepared to an urgent operation
You expect surgeons to do

Now you are GP
& you will prepare this patient for surgery
You will do all if the following except

Last
Postoperative management of this case must include

70 y old man has dyspepsia & epigastric pain doesn’t response to medical treatment
On examination he has cachexia & upper abdominal mass . You suspect

Examination revealed malignant mass in the middle third of stomach with operability
Treatment is

All of the following can cause cancer stomach except

DD epigastric mass includes All of the following except

Middle aged female has a history of osteoarthritis & NSAID intake for long period
Suddenly she developed hematemesis
You suspect

She asks you about NSAID , you will say

She feels worried about her condition
Tell her the truth