<prompt> Answer this question truthfullyWhat is Sandbox: mk? This sentence is already in proper English.  <response>: <reason> Patient usually appear in severe distress due to severe abdominal pain.Patient has normal vital signs in initial stages of peptic ulcer. In peptic ulcer perforations vital signs may include: Tachycardia with regular pulse Weak pulse low blood pressure with normal pulse pressure High-grade fever is present at later stage of peptic ulcer perforationPallor is present in patients presents with hematemesis and melena.Source- Dr Graham Beards Own work The hand of a person with severe anemia on the left compared to one without on the right Source -James Heilman, MD - Own work Pallor on the lower conjunctiva can be seen.Normal BL vesicular breath sounds.S1 and S2 normal,no murmurrubsgallops.Abdominal tenderness at the epigastrium Perforated peptic ulcer presents with Rebound tenderness Decreased bowel sound s Lower right quadrant tenderness Abdominal rigdity Abdominal distension 