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PEPTIC ULCER
AGGRESSIVE FACTORS•   hydrochloric acid•   pepsin•   reverse diffusion of ions of hydrogen•   products of lipid hyperoxida...
DEFENSE FACTORS• mucus and alkaline components of  gastric juice• property of epithelium of mucous  tunic to permanent ren...
PATHOMORPHOLOGY• Erosion• acute ulcers• chronic ulcers
CLASSIFICATION       by Johnson (1965)• I – ulcers of small curvature (for 3 cm  higher from a goalkeeper);• II– double lo...
CLINICAL MANAGEMENT•   Pain•   Vomiting•   Heartburn•   Belching
COMPLICATIONS•   Penetration•   Stenosis•   Perforation•   Bleeding•   Malignization
DIAGNOSIS PROGRAM•   1. Anamnesis and physical examination.•   2. Endoscopy.•   3. X-Ray examination of stomach.•   4. Exa...
X-Ray examinationTHE DIRECT SIGNS:• symptom of “Haudeks niche”• ulcerous billow and convergence of folds of mucous  tunic....
SYMPTOM    OF“Haudeks  niche”
STENOSIS
GASTROSCOPY
DEVICE FOR GASTRIC DOPPLEROGRAPHY
Endoscopic picture of the  normal stomach wall
Endoscopic picture of the      peptic ulcer
CONSERVATIVE THERAPYa) Omeprazole 20 mg 2 time per day or Н2-   blocker histamine receptor (ranitidine)   — 150 mg in the ...
SURGICAL TREATMEN•   at the relapse of ulcer after the course of    conservative therapy;•   in the cases when the relapse...
Billroth I and Billroth II resection
Billroth II resection
Billroth I resection:
DUODENAL ULCER
CLASSIFICATIONI. By etiology:   А. True duodenal ulcer.   B. Symptomatic ulcers.II. By passing of disease:   1. Acute (fir...
CLASSIFICATIONIII. By the stages of disease:   1. Exacerbation.   2. Scarring:       a) stage of “red” scar;       b) stag...
CLASSIFICATIONV. 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...
CLINICAL MANAGEMENT•   Pain•   Vomiting•   Heartburn•   Belching
DUODENOSCOPY
SYMPTOM OF        STENOSIS“Haudeks niche”
DIAGNOSIS PROGRAM•   1. Anamnesis and physical examination.•   2. Endoscopy.•   3. X-Ray examination of stomach and    duo...
CONSERVATIVE THERAPYa) Omeprazole 20 mg 2 time per day or Н2-   blocker histamine receptor (ranitidine) — 150   mg in the ...
INDICATIONS TO THE      ELECTIVE OPERATION•   1. Passing of duodenal ulcer with the    frequent relapses which could not  ...
METHODS OF SURGICAL    TREATMENT•   organ-saving operations;•   organ-sparing operations;•   resection.
TRUNK VAGOTOMY (TrV)   2          4
3SELECTIVE VAGOTOMY (SV)
SELECTIVE PROXIMAL  VAGOTOMY (SPV)
SELECTIVE PROXIMAL  VAGOTOMY (SPV)
Heineke-  Mikuliczpyloroplasty
Heineke-Mikulicz pyloroplasty
GASTRODUODENOSTOMY BY      JABOULAY
Finney pyloroplasty
ULCEROUS STENOSIS        CLASSIFICATIONA    I — compensated;    II — subcompensated;    III — decompensated.B    I — steno...
DIAGNOSIS PROGRAM•   1. Complaints of patient and anamnesis of    disease.•   3. Sounding of stomach and examination of   ...
ULCERSTENOSIS
PERFORATED GASTRODUODENAL ULCERS                CLASSIFICATION1. After etiology:• ulcerous;• unulcerous.2. After localizat...
DIAGNOSIS PROGRAM•   1. Anamnesis and physical examination.•   2. Global analysis of blood and urine, biochemical    blood...
Perforated ulcer(pneumoperitoneum)
Bleeding gastroduodenal ulcers        CLASSIFICATION• I degree is easy — observed at the loss to  20 % volume of circulato...
DIAGNOSIS PROGRAM•   Anamnesis and physical examination.•   Finger examination of rectum.•   Gastroduodenoscopy.•   Global...
ENDOSCOPYstopped bleeding
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Ulcerative disease of the stomach and duodenum

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Transcript of "Ulcerative disease of the stomach and duodenum"

  1. 1. PEPTIC ULCER
  2. 2. AGGRESSIVE FACTORS• hydrochloric acid• pepsin• reverse diffusion of ions of hydrogen• products of lipid hyperoxidation
  3. 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
  4. 4. PATHOMORPHOLOGY• Erosion• acute ulcers• chronic ulcers
  5. 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)
  6. 6. CLINICAL MANAGEMENT• Pain• Vomiting• Heartburn• Belching
  7. 7. COMPLICATIONS• Penetration• Stenosis• Perforation• Bleeding• Malignization
  8. 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. 9. X-Ray examinationTHE DIRECT SIGNS:• symptom of “Haudeks 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).
  10. 10. SYMPTOM OF“Haudeks niche”
  11. 11. STENOSIS
  12. 12. GASTROSCOPY
  13. 13. DEVICE FOR GASTRIC DOPPLEROGRAPHY
  14. 14. Endoscopic picture of the normal stomach wall
  15. 15. Endoscopic picture of the peptic ulcer
  16. 16. CONSERVATIVE THERAPYa) 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 eveningb) antiacid drugs — in accordance with the results of pH-metry;c) reparative drugs (dalargin, solcoseryl, actovegin) — for 2 ml 1–2 times per daysd) antimicrobial drugs (clarytromicine 500 mg twice daily, de-nol, metronidazole)
  17. 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.
  18. 18. Billroth I and Billroth II resection
  19. 19. Billroth II resection
  20. 20. Billroth I resection:
  21. 21. DUODENAL ULCER
  22. 22. CLASSIFICATIONI. 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. 23. CLASSIFICATIONIII. 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. 24. CLASSIFICATIONV. 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.
  25. 25. CLINICAL MANAGEMENT• Pain• Vomiting• Heartburn• Belching
  26. 26. DUODENOSCOPY
  27. 27. SYMPTOM OF STENOSIS“Haudeks niche”
  28. 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. 29. CONSERVATIVE THERAPYa) 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 eveningb) 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 daysd) antimicrobial drugs (clarytromicine 500 mg twice daily, de-nol, metronidazole)
  30. 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.
  31. 31. METHODS OF SURGICAL TREATMENT• organ-saving operations;• organ-sparing operations;• resection.
  32. 32. TRUNK VAGOTOMY (TrV) 2 4
  33. 33. 3SELECTIVE VAGOTOMY (SV)
  34. 34. SELECTIVE PROXIMAL VAGOTOMY (SPV)
  35. 35. SELECTIVE PROXIMAL VAGOTOMY (SPV)
  36. 36. Heineke- Mikuliczpyloroplasty
  37. 37. Heineke-Mikulicz pyloroplasty
  38. 38. GASTRODUODENOSTOMY BY JABOULAY
  39. 39. Finney pyloroplasty
  40. 40. ULCEROUS STENOSIS CLASSIFICATIONA I — compensated; II — subcompensated; III — decompensated.B I — stenosis of goalkeeper; II — stenosis of bulb of duodenum; III — postbulbar duodenal stenosis.
  41. 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.
  42. 42. ULCERSTENOSIS
  43. 43. PERFORATED GASTRODUODENAL ULCERS CLASSIFICATION1. 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. 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.
  45. 45. Perforated ulcer(pneumoperitoneum)
  46. 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. 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.
  48. 48. ENDOSCOPYstopped bleeding
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