The document discusses the surgical management of peptic ulcers. It outlines the diagnosis of peptic ulcers using tests like upper gastrointestinal studies and endoscopy. Conservative management involves lifestyle changes and medications like antacids, H2 blockers, and PPIs. Surgical options are considered for intractable or life-threatening ulcers and include procedures like Billroth II gastrectomy, gastrojejunostomy, truncal vagotomy and drainage, and highly selective vagotomy. Potential complications of surgical management are also detailed.

2. SURGICAL MANAGMENT OF
BY
Dr. Pirah Korai
FCPS-ii TRAINEE
CMC LARKANA

3. OUTLINES
Introduction
Diagnosis
Medical management
Surgical management

5. DIAGNOSIS
UGIS (Double contrast studies)
Endoscopy

8. MANAGMENT

9. Conservative
 Regular lifestyle
 Prohibition of the smoking and alcohol
 Diet (proteins, milk and milky
products)

10. MEDICAL OPTIONS
Antacids
Anticholinergics
H2 Blockers
PPIs

12. SURGICAL
MANAGMENT

13. INDICATIONS
Intractable ulcers
Life threatening complications of ulcer
(e.g bleeding, perforation, obstruction)

14. DUODENAL ULCER
Billroth ll Gastrectomy
Gastrojejunostomy
Truncul vagotomy and drainage
Higly selective vagotomy
Truncul vagotomy and antrectomy

17. Billroth ll operation

19. Billroth l Gastrectomy

21. COMPLICATIONS
Recurrent ulceration
Small stomach syndrome
Bile vomiting
Early dumping
late dumping
Postvagotomy diarrhea
Malignant transformation
Nutritional consequences
Gall stones

22. COMPLICATED PEPTIC ULCER