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Path: Small Bowel Disease (iii) (Duodenal ulcer (tx (H2 blockers, PPI…
Path: Small Bowel Disease (iii)
Acute appendicitis
most common surgical emergency
commoner in low fibre high protein diet
often a/w obstruction 50-80% of cases
continued secretion of mucin leads to increased intraluminal pressure + ischaemic injury, which reduces mucosal resistance to invasion by microorganisms
mucosal inflamm + ulceration
non-obstructive appendicitis can be secondary to generalised illness, usually viral
measles (Warthin-Kinkeldey giant cells)
EBV (infectious mononucleosis)
causes of appendiceal obstruction
faecolith (hard discrete mass of thick faeces)
foreign body (incl threadworms)
gallstones
tumour of caecum
tumour of appendix
diffuse lymphoid hyperplasia
clinical features
periumbilical colicky pain + vomiting
later localisation of pain to RIF
fever, leukocytosis, elevated ESR + CRP
perforation with peritonitis
types
acute focal
acute suppurative
gangrenous
perforative
complications
perforation with peritonitis
localised abscess
portal abscess
mortality (35% in 1900, now <1%)
Duodenal ulcer
PUD can affect the duodenum
decreasing incidence but still common
imbalance between gastric acid production vs protective factors of intact epithelium + bicarb production
increased gastric acid production requires intact funds mucosa
a/w with H pylori + gastric metaplasia, not a/w malignancy
symptoms
waking @ night with upper abdo pain
pain that improves upon eating
tx
H2 blockers
PPI (omeprazole)
triple therapy for H pylori (PPI, amoxicillin, clarithromycin)
80% heal within a month
surgery if haemorrhage, perforation, obstruction or failure to response to medical tx
usually single lesion within 2m of pylorus, margins well-defined, no heaped-up edges, may have large vessel with open lumen @ ulcer base
multiple lesions throughout duodenum suggest Zollinger-Eillison syndrome (gastrin-screwing tumour or hyperplasia of islet cells in pancreas - causes overproduction of gastric acid)
aetiology
hyperacidity
HLOs (helicobacter-like organisms)
NSAIDs
smoking
genetic (blood group O)
complications
haemorrhage
penetration of adjacent organs
perforation
anaemia
stricture