1. Alonzo.Amaro.Amolenda Anacta.Andal

2. Beginning Data  Male, 45 year old  Chief Complain: Severe Abdominal Pain

3. History of Present Illness 3 years PTA Crampy, epigastric pain Relieved by food intake or antacids Melena UGI endoscopy: Erosive Gastritis Unrecalled medications 1 year PTA Epigastric pain Melena Self ‐ medicated: Omeprazole

4. A few hours PTA Severe epigastric pain ADMISSION History of Present Illness

5. Past Medical History (-) HPN (-) DM Family History (-) Cancer

6. Personal History 10 pack ‐ years smoking Drinks alcoholic beverage for 8 years

7. Physical Examination  Conscious, coherent, in distress  BP= 140/90, PR= 105/min, RR=26/min,T= 37.8 C  Warm moist skin, no active dermatoses  Pink palpebral conjunctivae, anicteric sclerae  Heart and Lungs: regular rate and rhythm, clear breath sounds  Abdomen : flat, hypoactive bowel sounds, guarding and tenderness on all quadrants  DRE: brown stool on tactating finger

9. Salient Features Pertinent Subjective  Male, 45 y/o  Crampy, epigastric pain  Relieved by food intake or antacids  Melena  UGI endoscopy: Erosive Gastritis  10 pack ‐ years smoking  Drinks alcoholic beverage for 8 years Pertinent Objective PR= 105/min, RR=26/min Abdomen : flat, hypoactive bowel sounds, (+) guarding and tenderness on all quadrants DRE: brown stool on tactating finger

11. Clinical Impression  Peptic Perforation