Giant dus

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GIT Case Giant DU

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Giant dus

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