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Peptic ulcer disease
- 2. • ULCER DEVELOP IN INSIDE LINING OF STOMACH AND UPPER SMALL INTESTINE
- 3. COMMON SITE • DUODENUM • LESSER CURVE • STOMA • OESOPHAGUS • MECKELS
- 4. CAUSES • NSAID • H.PYLORI • SMOCKING • STRESS • SPICY FOOD
- 5. D.U • OLDER AGE • COMMON MALE
- 6. PATHOLOGY • FIBROSIS • PYLORIC STENOSIS • ANT WALL AND POST WALL ULCER---KISSING ULCER • ANT ULCER—PERFORATE • POST ULCER BLEEDS • MALIGNANCY UNCOMMON
- 7. G.U • LESS COMMON • NSAID • SMOCKING • M: F EQUAL • LOW SOCIO ECONOMIC CLASSES
- 8. PATHOLOGY • LARGER • FIBROSIS HOURGLASS STOMACH • EROSIN TO PANCREAS /MAJOR VESSELS/COLON • COMMON IN LESSER CURVE • ASSOCIATED WITH MALIGNANCY • BIOPSY
- 9. PYLORIC CHANNEL ULCER • SIMILAR TO D U • BIOPSIED
- 10. STOMAL ULCER • G J • JEJUNAL SIDE
- 11. C F • PAIN • PERIODICITY • VOMITING • WT LOSS • BLEEDING • ANAEMIA • MALENA
- 12. INVN • OGD SCOPY • BIOPSY---MALIGNANCY /C L O TEST
- 13. RX • MEDICAL • MODIFICATION OF LIFE STYLE • STOP SMOCKING • PROTON PUMP INHIBITORS • ACHLORHYDRIC
- 14. H.PYLORI • 1874 • HYDROLYSIS UREA PRODUCE AMMONIA • ANTRAL G CELLS PRODUCE GASTRIN • HYPERGASTRINAEMIA • GASTRIC ACID HYPER SECRETION • DISTRUPTION OF GASTRIC MUCOSA BARRIER BY ENZYMES • CYTOTOXINS PRODUCE GASTRITIS/P U/CANCER
- 15. • DUODENUM • NOT COLONIZED • CIRCULATING GASTRIN PRODUCE INCREASE ACID SECRETION LEADS TO DUODENITIS AND ULCER
- 16. CLO TEST /BREATH TEST • CAMPYLOBACTOR LIKE ORGANISM TEST
- 17. ERADICATION • PROTON PUMP INHIBITOR • TWO ANTIBIOTICS • METRO+ AMOXYCILLIN/CLARITHROMYCIN • 2 WKS • REINFECTION UNCOMMON
- 18. SURGERY • DIVERSION OF ACID • REDUCE ACID SECRETION
- 19. BILROTH 1
- 20. G J • ALKALINE REFLUX • REDUCE DUODENAL ACID EXPOSURE • STOMAL ULCER COMMON
- 21. T V & GJ • 1943 • REDUCES ACID SECRETION • GASTRIC STASIS • PYLOROPLASTY
- 22. HSV • 1968 • DENERVATION OF PARIETAL CELL MASS • MOST SATISFACTORY • LOW SIDE EFFECT • RECURRENCE CAN OCCUR
- 23. COMPLICATION • RECURRENT ULCER • BLEEDING • PERFORATION • FISTULA • RX—REVISIONAL SURGERY
- 24. SMALL STOMACH SYNDROME • EARLY SATIETY • LOSS OF RECEPTIVE RELAXATION
- 25. BILE VOMITING • VAGOTOMY AND DRAINAGE • RX –BILE CHELATING AGENT---INEFFECTIVE • REVISIONAL SURGERY • ROUX EN Y EFFECTIVE
- 26. EARLY DUMPING • ABDOMINAL PAIN • VASOMOTOR SYMPTOMS • 10% • FOLLOWING AND DRAINAGE • HIGH OSMOTIC LOAD • SEQUESTRATION OF FLUID
- 27. RX • DIETARY MANIPULATION • SMALL REGULAR MEALS • AVOID HIGH CARBOHYDRATE • SOMATOSTATIN BEFORE MEALS • REVISIONAL SURGERY
- 28. LATE DUMPING • REACTIVE HYPOGLYCEMIA • CARBOHYDRATE LOAD • RISE IN PLASMA GLUCOSE • INCREASE INSULIN LEVEL • SECONDARY HYPOGLYCEMIA
- 29. RX • SAME AS EARLY DUMPING
- 30. POST VAGOTOMY DIARRHEA • MOST DEVASTATING • 5% • AETILOGY—UNKNOWN • RAPID GASTRIC EMPTYING • SEVERE EXPLOSIVE • PASSING BOILED WATER • DIFFICULT TO TREAT • ANTI DIARRHEAL • REVISIONAL SURGERY
- 31. MALIGNANCY • 4 TIMES • INCREASED BILE REFLUX • INTESTINAL METAPLASIA • LAG PHASE 10 YEARS • HSV HIGH RISK
- 32. NUTRITIONAL • COMMON GASTRECTOMY • WT LOSS • ANAEMIA---VIT B12 DEF//IRON DEF • IRON DEFE----DECREASED IRON ABSORPTION • LOSS OF BLOOD • VIT 12 LATE PRESENTATION ---LARGE STORE
- 33. GALL STONE • ASSOCIATED WITH TV • BILIARY TREE DENERVATED • STASIS
- 35. G O O