Peptic Ulcer Flashcards
Definition of p.u
It is a chronic recurring disease characterised by defects of the mucous membrane of the stomach or duodenum due to des order of general and local mechanism of nervous hormonal immune regulation basically the imbalance between aggressive and defensive factors
Risk factors
Age
Smoking
Alcohol
Helicobacter infection
Diet
Stresssss
Aggressive and defensive factors influencing peptic ulcer
Aggressive factors
Helicobacter pylori
Acid peptic factor
Motility impairment
Corticosteroids
Neurohumoral effects
Defense factors
Buffer bicarbonate
Blood flow
Mucus
Regenerative capacity of epithelium
Classification of peptic ulcer
Duodenum-bulbar and extra bulbar
Stomach
According to numbers
Multiple single
According to phase of disease
Remission
Exacerbation
According to Johnson
Type l- localized ulcer above stomach angle
Type2- combined ulcer
Type3 - ulcer of pyloric part
According to complication
Uncomplicated and complicated
According to presence of h pylon
H-pylor+ h-pylor -
A. Of HCL secretion
Hyperchlorida
Normuchlordes
Hypo
Clinical P.
Pain in the epigastic region radiatesto the back thorax hypochondria
Nausea vomiting
Weakness sleep disturbance heartburn stool disturbare
Sweating loss ofweightlossofappetite
Note - pan for stomach 0.5 - hour
Duodenum 1.5-2 hour
Phases of Pu clinical course
Gastric _ lack of ulcerous defects, signs of chronic G. { pain, indigestion nausea vomiting
Ulcerous - unstable mucous defect
Visceropathic _ steady ulcerous the defects with functional dysfunction of other organs L{ pancreas gallbladder liver intestine
Dystrophic - weakness, decompensated stenosis cachexia
Diagnostic
Xray without contrast
Fibrogastroduodenoscopy
Hpylori investigation
Treatment
Encase of h-pylori antibiotic T
H2 blockers
Ranitidine
Proton pump inhibitor omeprazl9
Anti microbial drug
Clarthromycne
Amoxicillin
Surgery_ vagotomy with/colthout drainage operation
Resection af stomach
Drainage operation- pyloroplasty, gastroenterostomy/ antral resection antrumectomy
Types of vagotomy -selective selective proximal truncal/stem
Classification of resection -subtotal total hemi
Classification of resection- distal(fundus) proximal (body) medial (pylori)
Method of complete after resection of stomach
Gastroduodenal anastomosis
Gastrojejunal anastomosis
Absolute Indication forsurgery
Absolute indication
Ulcer perforation
Penetrating
GI Bleeding
Pyloric Stenosis
Ulcer malignancy
Relative indication for surgery
Visceropathic stage
Combined ulcer
multiple ulcer
ulcer recurrence after suturing
Complications of peptic ulcer
Bleeding
Pyloric stenosis
Perforation
Penetration
Perforating ulcer classification symptom s diagnostics and treatment plan
Intrusion of ulcer beyond the border of stomach wall and duodenum wall
According to etiology
in symptomatic ulcers
in peptic ulcer
A to periods of development
the period of “surgi- cal abdomen” (shock)
the period of false well- being
the period of spread peritonitis
stabbing” pain accompanied by arterial blood pressure downfall, cold perspiration, accelerated weak pulse rate
-plaque-like tension of the abdominal wall muscles (90%) due to which Schetkin’s symptom cannot be forced
Fgds X-ray laparoscopy ultrasonic investigation
Methods of treatment of perforating gastroduodenal ulcers
Operative methods Conservative methods
Palliative
Suturing of perforation.
Perforation closing by omentum strand.
Judd’s operation.
Radical
Truncal or selective vagotomy in combination with Judd’s operation.
Antral resection of the stomach in combination with selective vagotomy
For peptic ulcer radical t
Vagotomy + Judd’s operation
Antrumectomy + selective Vagotomy
Bleeding symptom s diagnostics and treatment plan
“coffee-ground” vomiting or vomiting of unchanged blood (hematemesis)
tarry, melena stools of “cherry jelly” type
weakness
dizziness
flickering of “flies” before the eyes
General symptoms (signs of bloodloss)
thirst tachycardia
dyspnea
noise in the ears
hypotension oliguria
FGDS
Deficiency of сirculating blood, hemodynamic indices
Coagulogram
endoscopic
irrigation, glue application, novocaine and adrenaline blockade, diathermocoagulation, laserocoagulation, clipping of the blood vessel
components of blood (fresh icy plasma, cryoprecipitate); hemostatics (dicynone, acidum έ-aminocapronicum, tranexam, contrykal)
antibiotics (clarithromycin, amoxicillin, metronidasolum); proton pump inhibitors (omeprasole)
components of blood (erythromass, plasma); blood substitutes (polyglucinum, reopolyglucinum, preparations of hydroxyethylglucogen, saline and glucose- containing solutions); preparations of blood (albumin, protein)
palliative (dissection of the bleeding ulcer, trimming of the blood vessels in the ulcer or of the ulcer itself); ligation of the gastric arterial blood vessels
radical (resection, pyloroplasty + vagotomy with carrying the ulcer away)
medicamen- tous
temporary arrest of bleeding
anti-ulcerous treatment
treatment of the bloodloss after-effects
surgical
final arrest of bleeding
treatment of the peptic ulcer
Pyloric stenosis
narrowing of the duodenal antral portion or pyloric portion of the stomach. Stenosis develops as a result of scarring of the ulcers localized in the pyloric canal or in the antral portion of the duodenum.
fClassification of pyloroduodenal stenosis
Cicatricial
Edematous stenosis stenosis
The origin of stenosis
stage of compensation
stage of subcompensation
stage of decompensation
Weight loss vomiting discomfort stool dehydration weakness thirst dark colored urine tachycardia fry mouth dry tongue
Compensated edematous stenosis
Anti-ulcerous therapy for 3 weeks, operative treatment may be possible later on.
Subcompensated edematous stenosis
Anti-ulcerous therapy, hemostasis disturbances’ correction. Surgical treatment may be possible after correction.
Subcompensated scarry stenosis
Hemostasis disturbances’ correction. Surgical intervention is performed after correction.
Decompensated scarry stenosis
In surgical treatment preference is given to organosparing interventions – SV (selective vagotomy) + drainage operation.
Resection of the stomach with SV is indicated in combined ulcers of the stomach and duodenum, as well as in combination of stenosis with other complications of peptic ulcer
