This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'Treatment of perforated peptic ulcer includes -a) i.v. fluidsb) Drainage of paracolic gutterc) Immediate surgeryd) Antacidse) i.v. pantoprazole \nSelect and explain. \nA. acd, B. bde, C. ace, D. ade', 'role': 'user'}, {'content': 'Answer: C \nExplanation: Management of Peptic ulcer perforation\n\nNasogastric tube: whenever a perforated ulcer is suspected, the first step is to pass a nasogastric tube and empty the stomach to reduce further contamination of the peritoneal cavity.\nIntravenous crystalloid: The patient is resuscitated aggressively by administration of intravenous crystalloid. Intravenous broad-spectrum antibiotics\n\nSurgery:\nSurgery is mostly indicated, although occasionally nonsurgical treatment can be used in stable patients without peritonitis, and in whom radiologic studies document a sealed perforation.\nSurgery whether laparoscopy or laparotomy involves two components:\ni)\xa0Thorough peritoneal toilet\n\nto remove all the fluid and food debris\n\xa0drain is not indicated\n\nii) Management of perforation\nFor duodenal ulcer perforation\n\nThe most frequently performed operation for a perforated duodenal ulcer is simple closure with an omental onlay reinforcement or patch.\nThis is combined with postoperative H. pylori eradication (antibiotics + antisecretory agents)\nInsertion of a nasoenteric or jejunal feeding tube should be considered\n\n\nFor gastric ulcer perforation\n\nAll perforated gastric ulcers are best treated by distal gastric resection with or without a truncal vagotomy (Truncal vagotomy can be added for type II & III gastric ulcers. Type I and IV gastric ulcers do not need acid reducing procedures as they are associated with hyposecretion). Ulcer is removed along with gastric resection as it carries a risk of malignancy (cf: duodenal ulcer has no risk of cancer). If ulcer is left behind, biopsy is always done.\n\n- Other procedures used for gastric ulcers are\n-\xa0\xa0\xa0\xa0 patch closure with biopsy - wedge excision and closure\nConservative Management:\nConservative management may be tried in stable patients without peritonitis, and in whom radiologic studies document a sealed perforation.\nIn conservative management, the patient is observed closely and treated with\n\nnasogastric suction,\nIV fluids\nintravenous acid secretion suppression, and\nintravenous broad-spectrum antibiotics.', 'role': 'assistant'}]