Peptic ulcers form in the stomach or duodenum due to an imbalance between acid secretions and mucosal defenses. Risk factors include H. pylori infection in 90% of cases, NSAID use, and stress. Complications include hemorrhage, perforation, and obstruction. H. pylori survives stomach acid through urease production. Diagnosis involves symptoms and imaging. Treatment depends on complications but usually involves antibiotics to eradicate H. pylori along with acid suppression. Surgery may be needed for perforation or obstruction.
Definitions of GI bleeding
GI Bleeding include Upper and Lower of GIB
Causes of GI bleeding
Pathogenesis of GI bleeding
Diagnosis of GI bleeding
Clinical of GI bleeding
Management of GI bleeding
Recommendation of GI bleeding
Clinical guideline of GI bleeding
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Intestinal fistulas pose the greatest challenge to the General Surgeon. The presentation provides abrief guideline for management of this complex problem.
Definitions of GI bleeding
GI Bleeding include Upper and Lower of GIB
Causes of GI bleeding
Pathogenesis of GI bleeding
Diagnosis of GI bleeding
Clinical of GI bleeding
Management of GI bleeding
Recommendation of GI bleeding
Clinical guideline of GI bleeding
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Intestinal fistulas pose the greatest challenge to the General Surgeon. The presentation provides abrief guideline for management of this complex problem.
complete treatment guidelines about the iron deficiency anaemia.it gives information about all forms of treatment.information given is more than enough for a medical student
In the vedio you can see how the presentation was supposed to be
The link :
http://www.youtube.com/watch?v=MFBdaSF-JqM
To download my Animated presentation vist
https://www.dropbox.com/s/qg6ie3mpcbvp793/Gastric.Ulcer.ToPost.pptx
Thanks for watching
AbstractIntestinal cystic pneumatosis is a rare condition characterized by the presence of gaseous cysts in the intestinal wall.We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes of abdominal pain who had a three-day cessation of materials and gas for three days.
AbstractIntestinal cystic pneumatosis is a rare condition characterized by the presence of gaseous cysts in the intestinal wall.We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes of abdominal pain who had a three-day cessation of materials and gas for three days
AbstractIntestinal cystic pneumatosis is a rare condition characterized by the presence of gaseous cysts in the intestinal wall.We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes of abdominal pain who had a three-day cessation of materials and gas for three days. The clinical ex-...
AbstractIntestinal cystic pneumatosis is a rare condition characterized by the presence of gaseous cysts in the intestinal wall.We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes of abdominal pain who had a three-day cessation of materials and gas for three days. The clinical ex-...
We report the observation of a 51-year-old patient with dyspepsia syndrome and recurrent episodes
of abdominal pain who had a three-day cessation of materials and gas for three days. The clinical examination on admission showed a slightly distended abdomen, an empty rectal bulb with digital rectal
examination. The biological assessment was without abnormality, the radiography of the abdomen
without preparation showed central hydro-aeric levels of the hail-like type with a gaseous crescent
inter hepato-diaphragmatic. The abdominal CT objectified a pneumoperitoneum with aerobilia, an
upper digestive distension with probable proximal digestive volvulus. The patient was admitted to
the block and an exploratory laparotomy was performed which revealed the presence of a gas cyst in
several places in the small intestine with distension of the latter upstream of a large mass of benign
appearance. Taking a segment of the jejunum. We carried out an anastomosis resection of the small
intestine carrying out the mass which we sent to the pathological anatomy laboratory and the result
of which returned in favor of intestinal cystic pneumatosis. The postoperative suites were simple with
good evolution and resumption of transit at end of the third day
Benigne diseases of stomach are one of the serious conditions of our world.... so here u get littlebit information about these diseases...hope it will help you for your future study about these diseases... thank you.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. DEFINITION
The term 'peptic ulcer' generally refers to an
ulcer or erosions in stomach or duodenum.
It may also occur in the jejunum after surgical
anastomosis to the stomach (Gastrojejunostomy)
or, rarely, in the ileum adjacent to a Meckel's
diverticulum.
4. Risk Factors
H.pylori infection : 90% of Peptic ulcer patients
are infected with H.pylori.
NSAIDs
Stress
Others :
Infection : CMV, HSV
Drugs : Bisphosphonates, Chemotherapy,
Clopidogrel, Crack cocaine, KCl
Glucocorticoids, Mycophenolate Mofetil,
Misc : Basophilia in Myeloproliferative disease,
Radiation therapy,Infiltrating disease,
Sarcoidosis, Crohn’s disease.
Life time risk of developing Peptic ulcer is 10%
5. Stomach Defense Systems
Mucous layer
◦ Coats and lines the stomach
◦ First line of defense
Bicarbonate
◦ Neutralizes acid
Prostaglandins
◦ Hormone-like substances that keep blood vessels
dilated for good blood flow
◦ Thought to stimulate mucus and bicarbonate
production
6. H. Pylori
HISTORY
• 1874 : Bircher first described the organism
• 1982 : Warren and Marshall confirmed Koch’s
postulates named it“campylobacter
pyloridis”
• 1985 : Association with peptic ulcer
• 1989 : Named as ‘helicobacter ‘(helico-curved)
7. H. Pylori
• H. pylori inf. is virtually always associated with chronic
active gastritis.
• But only 10–15% develop frank PUD.
• Transmission not yet known. Most likely route is feco-
oral.
• H. pylori is able to fight off the acid with the enzyme
urease.
• Urease converts urea into bicarbonate and ammonia,
which are strong bases.
• These acid neutralizing chemicals around the H. pylori
protect it from the acid in the stomach.
8. General Peptic Ulcer Symptoms
Epigastric tenderness
◦ Gastric: Epigastrium; left of midline
◦ Duodenal: mid to right of Epigastrium
Sharp, burning, aching, gnawing pain
Dyspepsia (indigestion)
Nausea/vomiting
Belching
9. Differentiating gastric from peptic
ulcer disease
Duodenal ulcers - age 25-75 years.
Gastric ulcer - age 55-65 years
Pain awakening patient from sleep between
12-3 a.m. present in 2/3 duodenal ulcer
patients and 1/3 gastric ulcer patients
10. Complications of Peptic Ulcers
Hemorrhage
◦ Blood vessels damaged as ulcer erodes into the muscles of
stomach or duodenal wall
◦ Coffee ground vomitus or occult blood in tarry stools
Perforation
◦ An ulcer can erode through the entire wall
◦ Bacteria and partially digested food spill into
peritoneum=peritonitis
Narrowing and obstruction (pyloric)
◦ Swelling and scarring can cause obstruction of food leaving
stomach=repeated vomiting
11. HEMORRHAGE
Upper GI bleeding is the most common
complication.
Sudden large bleeding can be life-threatening.
It occurs when the ulcer erodes one of the blood
vessels, such as the gastro duodenal artery.
With massive bleeding the patient vomits bright
red or coffee ground blood. Minimal bleeding
from ulcers is manifested by occult blood in a
tarry stool (malena).
12. Bleeding can occur as slow blood loss that
leads to anemia or as severe blood loss that
may require hospitalization or a blood
transfusion.
Occurs in about 15% cases.
More common in Elderly (>60 yrs)
13. OBSTRUCTION
Gastric outlet obstruction - scarring and
swelling due to ulcers causes pyloric
narrowing. Patient often presents with severe
vomiting.
Peptic ulcers can also produce scar tissue that
can obstruct passage of food through the
digestive tract, causing pt to become full
easily, to vomit and to lose weight.
14. Clinical feature & management
Long history of DU
Persistent vomiting
- Large & projectile
- Contain previous food elements
Epigastric fullness, visible peristalsis and
succussion splash
Dehydration & electrolyte disturbances
Metabolic alkalosis and tetany.
Wasting & malnutrition.
15. Treatment
Correct fluid & electrolytes disturbance and
improve nutrition
Treatment options include balloon dilation and
stenting, but surgery with drainage procedure is
usually required.
16. PERFORATION
Perforation often leads to catastrophic
consequences.
Erosion of the gastro-intestinal wall by the ulcer
leads to spillage of stomach or intestinal
content into the abdominal cavity.
Perforation at the anterior surface of the
stomach leads to acute peritonitis, initially
chemical and later bacterial peritonitis. The first
sign is often sudden intense abdominal pain.
Posterior wall perforation leads to pancreatitis;
pain in this situation often radiates to the back.
Perforation in the CBD- aerobilia, cholangitis
17. Perforated peptic ulcer
The first report of a series of patients
presenting with perforation of a duodenal
ulcer was made in 1817 by Travers.
The earliest operative description was made by
Mikulicz in 1884 but the first successful
operation for a perforated duodenal ulcer was
not until 1894.
18. Helicobacter pylori is implicated in 70–92% of all
Perforated Peptic Ulcers.
The second most common cause of perforated
duodenal ulcer is the ingestion of NSAIDs.
The least common cause is pathologic
hypersecretory states, such as Zollinger-Ellison
syndrome, although these should be considered
in all cases of recurrent ulcer after adequate
treatment.
19. Overall incidence for admission with peptic
ulceration is falling.
The number of perforated ulcers remains
unchanged.
Sustained incidence possibly due to increased
NSAIDs in elderly.
80% of perforated duodenal ulcers are H.
pylori positive.
Men are much more affected than women.
Ratio is approximately 12 : 1 to 20 : 1.
20. PATHOLOGY
Acute Perforation
◦ Stage of Peritonism
Acid peptic juice, bile and pancreatic juice come in
contact with general peritoneal cavity.
Pt cries out in severe pain during this stage.
◦ Stage of Reaction
Peritoneum reacts to the chemical insult by secreting
peritoneal fluid copiously(Sterile).
This gives relief to the pain and lasts for 3-6 hrs.
◦ Stage of Peritonitis
Acid secretion is abolished once perforation occurs.
Since there is no acid barrier, bacterial invasion
becomes easy
There is diffuse bacterial peritonitis.
21. DIAGNOSIS
The most characteristic symptom is the
sudden onset of Epigastric pain.
The pain rapidly becomes generalized
although occasionally it moves to the Rt Iliac
Fossa (Through Paracolic gutters).
The patient stays still.
22. There may be a history of previous
dyspepsia, previous or current treatment for
a Peptic Ulcer, or ingestion of NSAIDs.
On examination the patient is in obvious
pain.
The abdominal findings are characteristically
described as of board-like rigidity.
23. With time the patient may improve with
dilution of the duodenal contents by exudates
from the peritoneum but this is later replaced
by the signs and symptoms of bacterial
peritonitis.
Once an ulcer perforates, the subsequent
clinical picture is influenced by whether or
not the ulcer self seals.
24.
25. INVESTIGATIONS
Plain x-rays of the abdomen with the patient in
the upright position have been used in
diagnosing perforated ulcer. Chest X-ray
standing reveals free air under diaphragm.
Similarly, use of water-soluble contrast medium
with an upper gastrointestinal tract series or
computed tomography scan may increase the
diagnostic yield.
26. COMPLICATIONS
In most cases of perforation, gastric and
duodenal content leaks into the peritoneum.
This content includes gastric and duodenal
secretions, bile, ingested food, and swallowed
bacteria.
The leakage results in peritonitis, with an
increased risk of infection and abscess formation.
Subsequent collection of fluid in the peritoneal
cavity due to perforation and peritonitis leads to
inadequate circulatory volume, hypotension, and
decreased urine output.
27. Abdominal distension as a result of peritonitis
and subsequent ileus may interfere with
diaphragmatic movement, impairing expansion
of the lung bases.
Eventually, atelectasis develops, which may
compromise oxygenation of the
blood, particularly in patients with coexisting
lung disease.
In more severe cases, shock may develop.
28. Treatment Options
Principles of initial conservative treatment
include
nasogastric suction
pain control
antiulcer medication
Antibiotics
Several surgical techniques have been employed
in the treatment of perforated peptic ulcer.
These include conservative surgery with patching of the
ulcer, peritoneal lavage, and antiulcer medication.
Definitive surgery with truncal vagotomy, highly selective
vagotomy, or partial gastrectomy.
29. Non surgical treatment
In 1935 Wangensteen noted that ulcers are
able to self seal and reported on seven cases
treated without surgery.
In 1946 this observation was confirmed by
Taylor and he treated 28 cases without surgery
with good success.
This was in the context of the high mortality
and morbidity associated with surgical
management at the time.
30. In 1989 a trial from Hong Kong by Crofts et al.
showed that non-operative treatment for PPU
was accompanied by a low mortality rate and
was not associated with a large number of
complications when the gastroduodenogram
documented a sealed perforation .
31. In a tertiary care GI centre,
When the diagnosis of a perforated duodenal ulcer is
established the patient is aggressively
resuscitated, nasogastric suction begun, and broad
spectrum antibiotic cover instituted.
If a tension pneumoperitoneum embarrasses
respiration this can be aspirated to release the
pneumoperitoneum.
A gastroduodenogram is performed to confirm self-
sealing.
The peritonitis should resolve in 4 to 6 hours and if
there is continued major fluid loss after this time or if
there are progressive signs of peritonitis or increasing
pneumoperitoneum then surgical intervention is
required
32. Laparoscopic Surgery
The traditional management of a perforated
duodenal ulcer has been a Graham Omental
Patch and a thorough abdominal lavage.
More recently this has been shown to be able
to performed using a laparoscope. The only
proven advantage of the laparoscopic
technique appears to be decreased
postoperative pain.
Operating times are longer compared to open
techniques and hospital time appears to be
similar to conventional treatment.
33. Definitive surgery
There is good evidence that, in the emergency
situation, highly selective vagotomy (proximal
gastric, or parietal cell vagotomy) combined with
simple omental patch closure of the
perforation, in patients without the risk factors
mentioned above, is just as effective as that
performed in the elective setting .
This is associated with a less than 1% mortality
rate and a 4–11% ulcer recurrence rate. The
success of this operation is surgeon-dependent.
34. There has been a return to the use of simple
omental patch closure since the late 1970's
with the introduction of post-operative H2
antagonists and more recently Proton Pump
Blockers.
Over the last 10 years this trend has only grown
stronger due to the discovery of the role of H.
pylori in the pathogenesis of duodenal ulcer.
35. Given that H. pylori is able to be implicated in
up to 90% of perforated duodenal ulcers it
would seem logical to utilize patch closure and
subsequent antibiotic treatment of the
infectious agent saving definitive surgical ulcer
management for those who fail this regimen.