<prompt> Treatment of perforated peptic ulcer includes -a i.v. fluidsb Drainage of paracolic gutterc Immediate surgeryd Antacidse i.v. pantoprazoleacdbdeaceade  <response>: Management of Peptic ulcer perforationNasogastric 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.Intravenous crystalloid: The patient is resuscitated aggressively by administration of intravenous crystalloid. Intravenous broad-spectrum antibioticsSurgery:Surgery is mostly indicated, although occasionally nonsurgical treatment can be used in stable patients without peritonitis, and in whom radiologic studies document a sealed perforation.Surgery whether laparoscopy or laparotomy involves two components:i Thorough peritoneal toiletto remove all the fluid and food debris drain is not indicatedii Management of perforationFor duodenal ulcer perforationThe most frequently performed operation for a perforated duodenal ulcer is simple closure with an omental onlay reinforcement or patch.This is combined with postoperative H. pylori eradication antibiotics antisecretory agentsInsertion of a nasoenteric or jejunal feeding tube should be consideredFor gastric ulcer perforationAll 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.- Other procedures used for gastric ulcers are- patch closure with biopsy - wedge excision and closureConservative Management:Conservative management may be tried in stable patients without peritonitis, and in whom radiologic studies document a sealed perforation.In conservative management, the patient is observed closely and treated withnasogastric suction,IV fluidsintravenous acid secretion suppression, andintravenous broad-spectrum antibiotics. 