H. Pylori Infection NSAIDs Smoking & Alcohol Acid Hypersecretion StressFamily History of PUD.
Duodenal Ulcer Gastric ulcer Age Any age specially 30-40 middle age 50-60 Sex More in male More in maleOccupation Stress job eg. Manager Same Pain Epigastric , discomfort Epi. Can radiate to back Onset 2-3 hours after eating & Immediately after midnight eating Agg.by Hunger Eating
Duodenal Ulcer Gastric ulcerRelived by Eating Lying down or vomitingDuration 1-2 months Few weeksVomiting Uncommon Common(to relieve the pain)Appetite Good Pt. afraid to eatDiet Good , eat to relieve the pain Avoid fried foodWeight No wt. loss wt. LossHematemesis 40% 60%Melena 60% 40%
Stool fecal occult blood.CBC CBL.Rapid Urease test, ureabreath test H. Pylori.Upper GI Endoscopy.Barium meal X-Ray.
Any patient >50 y/o with new onset of symptoms In all patients with “Alarmingsymptoms” endoscopy is required. Dysphagia. Weight loss. Vomiting. Anorexia. Hematemesis or Melena.
AntacidsH2-receptor blocking agents.Proton pump inhibitors.Cytoprotective and antisecretory drugs.Antibiotics.
H. pylori Eradication Therapy:• Triple therapy: Proton pump inhibitor . 2 Antibiotics: • Metronidazole + Clarithromycin. • Clarithromycin + Amoxicillin. » In some regimens, H2-receptor blockers, e.g. ranitidine, are used instead of PPI.
Indications: Failure of medical treatment. Development of complications High level of gastric secretion and combined duednal and gastric ulcer. Principle: Reduce acid and pepsin secretion.
Vagotomy: Truncal Vagotomy with drainage. Highly selective Vagotomy. Combination of vagal denervation (vagotomy) + anterctomy.
Truncal vagotomy with drainage:Resect the major trunk of the vagus tothe stomach this will lead to: Decrease acid and pepsin secretion. Impair antral motility and drainage. – Two types of drainage: Pyloroplasty. Gastrojejnostomy.
Highly selective vagotomy: • It is a parietal cells vagotomy. • It can be done with or without drainage. • It is done by cut a branch of vagus of the body and the fundus this will lead to decrease HCl production.
Combination of vagotomy+anterctomy: Combination of vagal denervation & removal of the major area of gastric production.