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Peptic Ulcer, Atiacids, Histamine2 receptor antagonists, Proton pump…

- - - - Selective vagotomy
        
        Severs the branches that interrupt acid secretion
      - Parietal vagotomy
        
        Severs the part of vagus that innervaates the parietal acid-secreting cells
      - Truncal vagotomy
        
        severs the anterior and posterior trunks to decrease acid secretion and gastric motility
    - - ·Longitudinal incision made in the pylorus, closed transversely to permit the muscle to relax
        
        ·Enlarged outlet for enhancing gastric emptying that is reduced by vagotomy
    - - ·Small segment of duodenum, the pylorus and the antrum is resected · the stump of the duodenum is closed by suture and the side of the jejunum is anastomosed to the cut end of the stomach
        
        Acid-secreting portion is reduced
        
        Gastrin secreting cells are excised
        
        Gastric phase of digestion delayed
    - - Gastroduodenostomy ( Billroth I )
        
        Removal if the distal antrum and pylorus. Duodenum is anastomosed to the gastric stump
        
        limited resection
        
        lower cure rate than Billroth II
      - Gastrojejunostomy ( Billroth II )
        
        Removal of antrum and pylorus. Jejunum is anastimised to the gastric stump
        
        Pancreatic and bile secretions preserved
        
        Dumping syndrome
        
        Wider resection (~75%)
        
        Decreases the possibility of lymph node spread/ metastatic recurrence
- - - - Effects and side effects
    - - Prevention
      - Health promotion
  - - - Patient-controlled analgesia
    - - Chest infection
- - - - Therapeutic
        
        Diathermy/ Cauterization/ Clipping/ Adrenaline injection [haemostasis]
        
        Banding/ Sclerotherapy
        [varices]
        
        Ligation
        [polypectomy]
        
        Stenting
        [Stent/ NG tube]
        
        Lavage
        [remove clots/ debris/ food residue]
        
        Bougie [dilatation]
        
        Percutaneous Endoscopic Gastrostomy (PEG)
      - Diagnostic
        
        Visulaize the entire upper GI tract, obtain tissue specimens
    - - Distress
      - Oversedation
      - Hypoxia
      - Risk of aspiration (pharyngeal anaesthesia)
      - Perforation
      - Haemorrhage
      - Infection [Rare]
      - Cardic dysrhythmias