— 生理適應 · HARD · MCQ —
一位有消化性潰瘍病史（PUD）的病人出現突發性、劇烈上腹痛、腹部僵硬及休克跡象。最可能的併發症是什麼？
A client with a history of peptic ulcer disease (PUD) presents with sudden, severe upper abdominal pain, a rigid abdomen, and signs of shock. What is the most likely complication?
- AGastric outlet obstruction胃出口阻塞
- BPerforation of the ulcer✓ 正解潰瘍穿孔
- CBleeding ulcer出血性潰瘍
- DGastroesophageal reflux disease (GERD)胃食道逆流疾病（GERD）
— Explanation · 中文詳解 —
突發性劇烈腹痛、腹部僵硬（如木板樣腹）及休克是腹腔內遊離氣體（perforation）的典型表現，表示潰瘍已穿透胃壁或腸壁，導致內容物溢入腹腔，引發腹膜炎和全身性感染。其他併發症的症狀較不劇烈或呈現不同表現。
Sudden severe abdominal pain, a rigid (board-like) abdomen, and shock are classic features of free intraperitoneal air from perforation, indicating that the ulcer has penetrated through the gastric or intestinal wall, allowing contents to spill into the peritoneal cavity and causing peritonitis and systemic sepsis. The other complications present with less severe or different symptoms.
✦ 台美臨床差異
美國急診處理潰瘍穿孔時，會優先進行腹部立/臥位X光檢查以確認氣體；台灣亦同，但團隊協作流程可能更快。