Sonu, a 15 years old girl, a regular swimmer presents with sudden onset of pain in abdomen, abdominal distension and fever of 39deg C and obliteration fo the liver dullness. Most probable diagnosis is ?
Ans. is 'a' ie. Ruptured typhoid ulcer The clue to this answer is presence of this clinical sign in the pt. --) Obliteration of liver dullness. Obliteration of liver dullness : Right mid-axillary line is percussed from above downwoards. The percussion note will be resonant in the upper pa of the mid-axillary line. At the upper border of the liver the resonant note in replaced by the dull note. If the liver dullness is replaced by a resonant note it indicates presence of free gas under the diaphragm as occurs in the perforation of the gastro-intestinal tract." - S.Das Manual, 4/e, p344 No other condition is able to cause obliteration of liver dullness.
Ruptured typhoid ulcer
Primary bacterial peritonitis
Ruptured ectopic pregnancy
UTI with PID.