Peptic ulcer disease patient appears in severe stress due to abdominal pain. Common physical examination findings of peptic ulcer disease include epigastric tenderness, tachycardia.Perforated peptic ulcer disease patient presents with classic triad of severe epigastric tenderness, tachycardia and abdominal rigidity. Clinical signs of perforated peptic ulcer comes in 3 stages: In the initial stage within first 2 hours, the patient presents with tachycardia, epigastric pain and cool extremities.In next 2 to 12 hours, the patient presents with lower right quadrant tenderness and abdominal rigidity. In more than 12 hours, the patient presents with abdominal distension, hypotension, and pyrexia with acute circulatory collapse.

• Patients usually appear in severe distress due to severe abdominal pain

• Patient has normal vital signs in initial stages of peptic ulcer
• In peptic ulcer perforations vital signs may include :^[1]
  • Tachycardia with regular pulse
  • Weak pulse
  • Low blood pressure with normal pulse pressure
  • High-grade fever is present at later stage of peptic ulcer perforation

• Pallor is present in patients presenting with hematemesis and melena

• Pallor on the lower conjunctiva can be seen

• Normal bilateral vesicular breath sounds

• S1 and S2 normal, no murmur/rubs/gallops

• Abdominal tenderness at the epigastrium
• Perforated peptic ulcer presents with:^[3][4][5]
  • Rebound tenderness
  • Decreased bowel sounds
  • Lower right quadrant tenderness
  • Abdominal rigdity
  • Abdominal distension

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