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Giant dus
 

Giant dus

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GIT Case Giant DU

GIT Case Giant DU

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    Giant dus Giant dus Presentation Transcript

    • Giant DUS:
    • History:
      • 16 years boy, student with H/O chronic dyspepsia & vomiting for the last 2 years.
      • GOO was diagnosed & surgery was done.
      • Now presented with dyspepsia,vomiting, weight loss& fever.
      • No diarrhea.
    • O/E:
      • Pale.
      • Thin built.
      • No goitre or LAP.
      • Abd soft with no organomegaly or ascites.
    • Recurrent giant stomal ulcer in RIY DJ:
    • Recurrent giant stomal ulcer in RIY DJ:
    • Definition/epidemiology
      • An ulcerative crater >2 cm, occupying most of duodenal balb.
      • Usually involving a large portion of the duodenal bulb
      • 1%-2% of all duodenal ulcers & 5% of peptic ulcers requiring surgical intervention.
      • M/F in standard sized ulcer disease is 2.3/1, 3/1 for GDUs.
    • Causes:
      • HP.
      • NSAIDs.
      • Primary Duodenal Cancer 15%.
      • ZES,Crohns.
      • Lymphoma,TB(2%)
      • Eso GE ITIS.
    • Features:
      • More complications: bleeding,GOO,Perforation, fistlulaformation, systemic inflammatory response as fever,weight loss.
    • Management:
      • Intensive PPI + Anti HP.
      • Stop NSAIDs& smoking.
      • Close observation & repeat endoscopic evaluation.
      • Endoscopic biopsies to test for malignant etiologies of giant ulcers, which may be more common than suspected.
      • Biopsies should be performed on all duodenal ulcers > 2 cm in diameter, particularly those with nodular appearing edges.
    • Refractory ulcers:
      • Those that fail to heal despite 8 to 12 weeks of antisecretory therapy
      • surveillance endoscopyshould be considered until healing is documented or until the etiology is defined (eg, surreptitious NSAID use, high gastrin states, ischemia).
      • Surgical consultation may be considered for persistent nonhealing PUD
    • Giant gastric ulcers:
      • (>3 cm) accounted for as many as 10- 24% of all gastric ulcers.
      • With the current widespread use of antisecretory
      • Tend to be older and may present with atypical symptoms including anorexia and weight loss.
      • These patients often have more aggressive disease, with a higher incidence of bleeding, higher mortality rates (10% vs 3%), greater need for urgent surgery (65% vs 12%).