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Peptic ulcer complications (Definition break of the continuity of the…
Peptic ulcer complications
Definition
break of the continuity of the epithelium ( more males:females , more duodenal: gastric )
common causes
1- H.pylori(
duodenal
+gastric)
H.pylori (urease==>CO2+
ammonia
)
2- NSAIDs(gastric)
inh. prostaglandins
synth direct damage mucosa
3- Smoking
:no_entry:dec.the blood supply :no_entry:dec.prostaglandins
4- Genetics
Protective mechanisms
:warning:
bicarbonate ..
mucosal blood flow
prostaglandins
mucus
Duodenal ulcer
Males :females 2:1 :check: (group
A blood group
) H.pylori .
pain relieved?food , drugs
:confetti_ball:
Diagnostic tests for ulcerations :
:confetti_ball:
1- Stool occult blood.
2- Rapid urease test.
3- endoscopy
Classification of ulcers :
5 types : : :
:fire:
Type one:
Ulcer along the body(along the lesser curve)at (incisura angularis along the locus minoris resistentiae).
:forbidden:Not asso. acid hypersecretion.
:check:Asso. blood type A.
:fire:
Type two:
Ulcer in the body in with duodenal ulcers.
:check:Asso. (acid oversecretion+blood type O).
:fire:
Type three:
In the pyloric canal within 3 cm of pylorus.
:check:Asso.acid oversecretion.
:fire:
Type four:
Proximal gastroesophageal ulcer
:fire:
Type five:
throughout the stomach
:check: Asso. chronic NSAIDs
Complications of peptic ulcer:
:no_entry:
1-Perforation :
Most
common
complication (inc. with fasting ):check:present with severe diffuse abdominal pain and fever .
:fire: Bad
prognostic features;
1-Diagnosis after 48h
2-shock
3- Large ulcer
4- Medical comorbidities
5- Advanced age (>75)
:fire:
diagnose :
-standing X-ray.
-lat.decubits X-ray:explode:
-CT-scan with oral contrast:explode::explode:
:fire:X-ray:
Abscess , intraperitoneal gas in
right
diaphragm
:fire:TX:
1-conservative ( IV.flu,NG,proph.A.B ).
2- surgery
3-lavage 6L- NS
4- postop:NG suction,PPI.
:fire:
Surgery and indications:
:no_entry:
in the past:
1-in compromised patients
==>:check: omental patch (graham's patch)(RELEAK10% MORB.3%,MORT.0-10%,(ABSCES))
2-in normal one :
-selective vagotomy
-trunkal vagoatomy
-total gastrotomy w/t bypass
2- Bleeding
:recycle:symptomes of Upper GI bleeding
-Hematemesis( coffee-ground emesis).
-melena .
-hematochezia.
-shock .
:explode:
MANAGEMENT of Upper GI bleeding:
:explode:(as any shock)NG tube,Fluid replacement ,PPI,Foley's catheter
:explode: :explode:Endoscopy ( diagnostic and therapeutic )
:explode: :explode::explode:
Surgery
:no_entry:
Indication
5 more items...
:explode:Endoscopic appearance of ulcer
https://cutt.us/r81AQ
:no_entry:
Grade 1A
spurting hemorrhage(High risk)
:no_entry:
Grade 1B
oozing hemorrhage
:no_entry:
Grade 2A
Non-bleeding visible vessel
:no_entry:
Grade 2B
adherent clot ( low-risk )
:no_entry:
Grade 2C
a flat, pigmented spot
:no_entry:
Grade 3
clean base
blood supply
https://cutt.us/UeHbv
3- Stenosis
Gastric outlet obstruction
:two types reversible or irreversible
:check: pyloric stenosis presentation :
Vomiting
Non specific :
( epigastric pain, weight loss, anaroxia,early satiaty,
:explode:succussion splash)
:check:
Investigations
1.upper endoscopy :explode:
2.CT scan with oral contrast ( barium ). :explode:
:no_entry:-if
reversible
stabilize the patient hemodynamicly , NG suction , IV fluids ( metabolic alkalosis ) , monitior urine output and give IV PPi
.:no_entry::no_entry::no_entry::no_entry:
1- 50% respond to conservative treatment :smiley:
2-if conservative failed :checkered_flag: => endoscopy to dilate the pylorus .
3- if endoscopy failed=> :explode: surgery (gastroenterostomy rather than a pyloroplasty)
Dumping syndrome (rapid gastric
emptying )
https://cutt.us/k6RBb
:check:Early 10 to 30 min
:check:Late 2 to 3 h
results from excessive movement of sugar into the intestine=> raises blood glucose l=>
insulin