2. AGGRESSIVE FACTORS
• hydrochloric acid
• pepsin
• reverse diffusion of ions of hydrogen
• products of lipid hyperoxidation
3. DEFENSE FACTORS
• mucus and alkaline components of
gastric juice
• property of epithelium of mucous
tunic to permanent renewal
• local blood flow of mucous tunic and
submucous membrane
5. CLASSIFICATION
by Johnson (1965)
• I – ulcers of small curvature (for 3 cm
higher from a goalkeeper);
• II– double localization of ulcers
simultaneously in a stomach and
duodenum;
• III – ulcers of goalkeeper part of
stomach (not farther as 3 cm from a
goalkeeper)
8. DIAGNOSIS PROGRAM
• 1. Anamnesis and physical examination.
• 2. Endoscopy.
• 3. X-Ray examination of stomach.
• 4. Examination of gastric secretion by the
method of aspiration of gastric contents.
• 5. Gastric pH metry.
• 6. Multiposition biopsy of edges of ulcer and
mucous tunic of stomach.
• 7. Gastric Dopplerography.
• 8. Sonography of abdominal cavity organs.
• 9. General and biochemical blood analysis.
• 10. Coagulogram.
9. X-Ray examination
THE DIRECT SIGNS:
• symptom of “Haudek's niche”
• ulcerous billow and convergence of folds of mucous
tunic.
INDIRECT SIGNS:
• symptom of “forefinger” (circular spasm of muscles)
• segmental hyperperistalsis,
• pylorospasm,
• delay of evacuation from a stomach
• duodenogastric reflux
• disturbance of function of cardial part
(gastroesophageal reflux).
16. CONSERVATIVE THERAPY
a) Omeprazole 20 mg 2 time per day or Н2-
blocker histamine receptor (ranitidine)
— 150 mg in the evening, famotidine —
40 mg at night, roxatidine — 150 mg in
the evening
b) antiacid drugs — in accordance with the
results of pH-metry;
c) reparative drugs (dalargin, solcoseryl,
actovegin) — for 2 ml 1–2 times per days
d) antimicrobial drugs (clarytromicine 500
mg twice daily, de-nol, metronidazole)
17. SURGICAL TREATMEN
• at the relapse of ulcer after the course of
conservative therapy;
• in the cases when the relapses arise during
supporting antiulcer therapy;
• when an ulcer does not heal over during 1,5–2
months of intensive treatment, especially in
families with “ulcerous anamnesis”;
• ulcer with complications (perforation or
bleeding);
• at suspicion on malignization ulcers, in case
of negative cytological analysis.
22. CLASSIFICATION
I. By etiology:
А. True duodenal ulcer.
B. Symptomatic ulcers.
II. By passing of disease:
1. Acute (first exposed ulcer).
2. Chronic:
a) with the rare exacerbation;
b) with the annual exacerbation;
c) with the frequent exacerbation (2 times
per a year and more frequent).
23. CLASSIFICATION
III. By the stages of disease:
1. Exacerbation.
2. Scarring:
a) stage of “red” scar;
b) stage of “white” scar.
3. Remission.
IV. By localization:
1. Ulcers of bulb of duodenum.
2. Low postbulbar ulcers.
3. Combined ulcers of duodenum and stomach.
24. CLASSIFICATION
V. By sizes:
1. Small ulcers up to 0,5 cm.
2. Middle — up 1,5 cm.
3. Large — up to 3 cm;
4. Giant ulcers over 3 cm.
VI. By the presence of complications:
1. Bleeding.
2. Perforation.
3. Penetration.
4. Organic stenosis.
5. Periduodenitis.
6. Malignization.
28. DIAGNOSIS PROGRAM
• 1. Anamnesis and physical examination.
• 2. Endoscopy.
• 3. X-Ray examination of stomach and
duodenum.
• 4. General and biochemical blood
analysis.
• 5. Coagulogram.
29. CONSERVATIVE THERAPY
a) Omeprazole 20 mg 2 time per day or Н2-
blocker histamine receptor (ranitidine) — 150
mg in the evening, famotidine — 40 mg at
night, roxatidine — 150 mg in the evening
b) antiacid drugs — (almagel, maalox or
gaviscon —1 dessert-spoon in a 1 hour after
food intake);
c) reparative drugs (dalargin, solcoseryl,
actovegin) — for 2 ml 1–2 times per days
d) antimicrobial drugs (clarytromicine 500 mg
twice daily, de-nol, metronidazole)
30. INDICATIONS TO THE
ELECTIVE OPERATION
• 1. Passing of duodenal ulcer with the
frequent relapses which could not
treated conservatively.
• 2. Repeated ulcerous bleeding.
• 3. Stenosis of outcome part of stomach.
• 4. Chronic penetration ulcers with the
pain syndrome.
• 5. Suspicion for malignization ulcers.
40. ULCEROUS STENOSIS
CLASSIFICATION
A
I — compensated;
II — subcompensated;
III — decompensated.
B
I — stenosis of goalkeeper;
II — stenosis of bulb of duodenum;
III — postbulbar duodenal stenosis.
41. DIAGNOSIS PROGRAM
• 1. Complaints of patient and anamnesis of
disease.
• 3. Sounding of stomach and examination of
gastric content.
• 4. Fibergastroduodenoscopy, biopsy.
• 5. Intragastric рН-metry.
• 6. Study of motility of stomach.
• 7. Roentgenologic examination of stomach and
duodenum (structural features, passage).
• 8. Sonography.
43. PERFORATED GASTRODUODENAL ULCERS
CLASSIFICATION
1. After etiology:
• ulcerous;
• unulcerous.
2. After localization:
• gastric (small curvature, cardial, antral,
prepyloric, pyloric) ulcer, front and back walls;
• ulcers of duodenum (front and back walls).
3. After passing:
• perforated in an abdominal cavity;
• covered perforations;
• atypical perforations.
44. DIAGNOSIS PROGRAM
• 1. Anamnesis and physical examination.
• 2. Global analysis of blood and urine, biochemical
blood test,
• coagulogram.
• 3. X-Ray examination of abdominal cavity organs
for presence of free gas (pneumoperitoneum).
• 4. Pneumogastrography, contrasting
pneumogastrography.
• 5. Fiber-gastroduodenoscopy.
• 6. Sonography of abdominal cavity organs.
46. Bleeding gastroduodenal ulcers
CLASSIFICATION
• I degree is easy — observed at the loss to
20 % volume of circulatory blood (at a
patient with weight of body 70 kg it is up
to 1000 ml);
• II degree — middle weight is loss from 20
to 30 % volume of circulatory blood (1000–
1500 ml);
• The III degree is heavy — is observed at
loss of blood more than 30 % volume of
circulatory blood (1500–2500 ml).
47. DIAGNOSIS PROGRAM
• Anamnesis and physical examination.
• Finger examination of rectum.
• Gastroduodenoscopy.
• Global analysis of blood.
• Coagulogram.
• 7. Biochemical blood test.
• X-Ray examination of gastrointestinal tract.
• Electrocardiography.
