PEPTIC ULCER SURGERY
COMPLICATIONS   RECURRENT ULCERATION   SMALL STOMACH SYNDROME   BILE VOMITING   DUMPING SYNDROMES     EARLY     LATE...
RECURRENT ULCERATION INCIDENCE OF RECURRENCE          OPERATION               INCIDENCE     GASTRECTOMY           1-4    ...
REC. ULCERATION…. SITE    HSV - 1ST PART OF DUODENUM    GJ - AT ANASTOMOSIS ON JEJUNAL SIDE       (JEJUNAL MUCOSA MORE...
REC. ULCERATION… COMLICATIONS    BLEEDING    PERFORATION    GASTROJEJUNOCOLIC FISTULA       ANASTOMOTIC ULCER PENETRA...
SMALL STOMACH SYNDROME EARLY SATIETY DUE REDUCTION IN THE SIZE OF  STOMACH IN HIGHLY SELECTIVE VAGOTOMY -- LOSS OF  RECE...
BILE VOMITING AFTER ANY FORM OF VAGOTOMY WITH  DRAINAGE OR GASTRECTOMY EATING PRECIPITATES PAIN &REFLUX SYMPTOMS VOMITS...
EARLY DUMPING INCIDENCE IN10% OF PTS. FOLLOWING  GASTRECTOMYOR VAGOTOMY&DRAINAGE AND  RARELY FOLLOWING HSV SYMPTOMS – AB...
LATE DUMPING INCIDENCE 5% REACTIVE HYPOGLYCEMIA MECHANISM - CARBOHYDRATE LOAD IN STOMACH CAUSES HYPERGLYCEMIA WHICH INT...
FEATURES OF EARLY&LATE DUMPING         FEATURE            EARLY                  LATEINCIDENCE           5-10%            ...
TREATMENT OF DUMPING SYNDROMES SAME FOR BOTH EARLY & LATE DIETARY MANIPULATION SMALL DRY  MEALS,AVOID FLUIDS WITH HIGH  ...
POST VAGOTOMY DIARHOEA
EARLY DUMPING… TREATMENT
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Complications ofulcer surgery

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Complications ofulcer surgery

  1. 1. PEPTIC ULCER SURGERY
  2. 2. COMPLICATIONS RECURRENT ULCERATION SMALL STOMACH SYNDROME BILE VOMITING DUMPING SYNDROMES  EARLY  LATE POST VAGOTOMY DIARRHOEA MALIGNANT TRANSFORMATION NUTRITIONAL CONSEQUENCES GALLSTONES
  3. 3. RECURRENT ULCERATION INCIDENCE OF RECURRENCE OPERATION INCIDENCE GASTRECTOMY 1-4 GASTRECTOMY ALONE 50 TRUNCAL 2-7 VAGOTOMY+DRAINAGE SELECTIVE VAGOTOMY 5-10 +DRAINAGE HIGHLY SEL.VAGOTOMY 2-10 T.V&ANTRECTOMY 1
  4. 4. REC. ULCERATION…. SITE  HSV - 1ST PART OF DUODENUM  GJ - AT ANASTOMOSIS ON JEJUNAL SIDE  (JEJUNAL MUCOSA MORE SENSITIVE TO ACID DIGESTION)  GASTRECTOMY - JEJUNAL SIDE OF THE STOMA MC PRESENTING SYMPTOM - PAIN RISK FACTORS  TECHNICALLY INADEQUATE OPERATION  CIGARATE SMOKING  REFRACTORY ULCERS BEFORE OPERATION
  5. 5. REC. ULCERATION… COMLICATIONS  BLEEDING  PERFORATION  GASTROJEJUNOCOLIC FISTULA  ANASTOMOTIC ULCER PENETRATES INTO TRANSVERSE COLON  SYMPTOMS  SEVERE DIARRHOEA AFTER EVERY MEAL  FOUL BREATH &MAY VOMIT FORMED FECES  NUTRITIONAL DISTUBANCES(DUE TO SEVERE CONTAMINATION OF JEJUNUM WITH COLONIC BACTERIA  INVESDTIGATIONS - BARIUM ENEMA,CT SCAN , ENDOSCOPY , BARIUM MEAL  TREATEMENT -CORRECTION OF DEHYDRATION & , MALNUTRITION,REVISIONAL SURGERY
  6. 6. SMALL STOMACH SYNDROME EARLY SATIETY DUE REDUCTION IN THE SIZE OF STOMACH IN HIGHLY SELECTIVE VAGOTOMY -- LOSS OF RECEPTIVE RELAXATION IMPOOVES WITH TIME NO NEED OF REVISIONAL SURGERY
  7. 7. BILE VOMITING AFTER ANY FORM OF VAGOTOMY WITH DRAINAGE OR GASTRECTOMY EATING PRECIPITATES PAIN &REFLUX SYMPTOMS VOMITS A MIXTURE OF FOOD & BILE OR SOME TIMES BILE ALONE AFTER MEAL TREATEMENT  REVISIONAL SURGERY  GASTRECTOMY - ROUX-EN Y DIVERSION  GJ – TAKEN DOWN & SMALL PYLOROPLASTY IS DONE  PYLOROPLASTY – ANTRECTOMY & ROUX-EN-Y RECONSTRUCTION
  8. 8. EARLY DUMPING INCIDENCE IN10% OF PTS. FOLLOWING GASTRECTOMYOR VAGOTOMY&DRAINAGE AND RARELY FOLLOWING HSV SYMPTOMS – ABDOMINAL&VASOMOTOR MECHANISM  SMALL BOWEL IS FILLED WITH FOOD STUFFS FROM STOMACH WHICH HAVE HIGH OSMOTIC LOAD  LEADS TO SEQUESTRATION OF FLUID FROM CIRCULATION INTO GIT
  9. 9. LATE DUMPING INCIDENCE 5% REACTIVE HYPOGLYCEMIA MECHANISM - CARBOHYDRATE LOAD IN STOMACH CAUSES HYPERGLYCEMIA WHICH INTURN RISES INSULINLEVELS RESULTING IN SECONDARY HYPOGLYCEMIA
  10. 10. FEATURES OF EARLY&LATE DUMPING FEATURE EARLY LATEINCIDENCE 5-10% 5%RELATION TO MEALS ALMOST IMMEDIATE SECOND HOUR AFTER MEALDURATION 30-40 MIN 30-40 MINRELIEF LYING DOWN FOODAGGRAVATEDBY MORE FOOD EXCERCISEPRECIPITATING FOOD ,ESPECIALLY AS EARLY DUMPINGFACTOR CARBOHYDRATE RICH&WETMAJOR SYMPTOMS EPIGASTRIC FULLNESS, TREMOUR,FAINTNESS, SWETTING, PROSTRATION LIGHTHEADEDNESS, TACHYCARDIA,COLIC, SOMETIMES DIARRHOEA
  11. 11. TREATMENT OF DUMPING SYNDROMES SAME FOR BOTH EARLY & LATE DIETARY MANIPULATION SMALL DRY MEALS,AVOID FLUIDS WITH HIGH CARBOHYDRATE CONTENT SOMASTATIN ANALOGUE OCTREOTIDE BEFORE MEALS REVISIONAL SURGERY  GJ – DRAINAGE IS TAKEN DOWN  PYLOROPLASTY – REPAIRGASTRECTOMY - ANTRERCTOMY&ROUX-EN-Y RECONSTRUCTION
  12. 12. POST VAGOTOMY DIARHOEA
  13. 13. EARLY DUMPING… TREATMENT
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