laparoscopic surgery of the abdomen. bruce v.,macfadyen jr. editors: springer. 2003
TRANSCRIPT
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Laparoscopic surgery of the abdomen. Bruce V.,MacFadyen Jr. Editors: Springer. 2003
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The role of endoscopy in the management of patients with peptic ulcer disease Guideline; the American
Society for Gastrointestinal Endoscopy: N 4, 2010;
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Institute of Statistics of Republic of Uzbekistan 2013
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Spreading of gastric and duodenal ulcer Gender differences
Duodenal ulcer is more prevalent in young males
Gastric ulcer disease occurs more in males after age of 50
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Institute of Statistics of Republic Of Uzbekistan 2013
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Sceletothopy of the stomach and duodenum
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Syntopy of the stomach
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Anatomical parts of the stomach
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X-ray picture of the stomach
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Ligaments of the stomach
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Blood circulation of the stomach
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Innervation of the stomach
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Erosion – superficial defect of the mucous layer
Ulcer - deep defect of the mucous layer
Submucous layer
Muscle layerSerous layer
Mucous layer
Submucous layer
Muscle layer
Mucous layer
Serous layer
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Endoscopic picture of the acute and chronic ulcer
Acute ulcer Chronic ulcer
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Ulcerogenous factors•Congenital Parietal cells abunancy, nerve system reactivity features; 1- blood group.•Stress hypergastrosis: profession; psychological trauma; burning, sepsis.•Bias of stomach function: Acid- peptic secretion inducing, mucous layer metaplasia•Antroduodenal dysmotoric:
Elevated evacuation, gastrostasis, duodeno-gastral reflux•Food intake regimen violation: Chronic hungriness•Drugs: Aspirin, indometacin, glucocorticoids,•Endocrin influence:
hypoglykemia,, pancreatits; Elisson-Solinger syndrome; Parathyroid adenoma; pituitary adenoma, Adrenal adenoma.•Chronic hepatic diseases (cirrhosis): histamine, gastrin overproduction; mucous content alteration.•Renal diseases: hypergastrinemia, hypercalcinemia, metabolic acidosis; uremic intoxication
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Stomach flied
mucous membrane
epithelial cells
Acid neutralization
Damage mucous membrane
Inflammation mucous membrane
Water +
urea
Death of epithelial cells
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Defention factors Alteration factors
• Mucous resistancy• Antroduodenal acid buffer
balance• Alkaline secretion• Food
• Pepsin and cloride acid (НСl)
• Gastro-duodenal dismotoric damage
• Mucous injuries
=
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Complaints:
Basic:• Epigastral pain
Additional:• Heartburn (pyrosis),• Nausea, vomiting,• Alteration of digestion,• Eructation.
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Gastric ulcer Duodenal ulcer
Early: pain occurs only 15-40 minutes after food intake
Late: pain occurs only 2 hours after food intake
Season independent Season dependent: mainly in autumn and spring
Not depended to daytime Night pains (n. vagus), Hungriness pains: ends buffer feature of food
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Objective exam:
• Astenic body shape• Alteration of vegetative nerve system: hypotonia, bradycardia, over-perspiration(cold weet feet), visual dermographism (reddish skin color.)
• In the beginning of disease patients eat more than usual (in order to neutralize the gastric acid). Loss of weight consistently.
• White tongue incrustation. • Pain and tenderness at the right upper side of abdomien.
No special symptoms
Generally
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Special diagnostic alternatives
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Ulcer
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Kay histamine probe
1. Aspiration of stomach liquid every 15 minutes during 1 hour.
2. I/m 0,1% histamine injection.
3. Aspiration of stomach liquid every 15 minutes during 1 hour.
4. Assessment of chloride acid concentration in obtained liquid.
Normal basal secretion is 5 mmol/hour , after stimulation– 16 – 25 mmol/hour.
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Cholander`s probe
1. Aspiration of stomach liquid every 15 minutes during 1 hour
2. Subcutaneous insulin injection.
3. Aspiration of stomach liquid every 15 minutes during 1 hour.
4. Assessment of chloride acid concentration in obtained liquid.
Cholander probe is positive, only in cases of chloride acid concentration elevation after insulin injection
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Differential Diagnostic
•Stomach cancer•Acute and chronic cholecystitis•Acute and chronic pancreatitis•Acute appendicitis
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• Ranitidine is less dyspeptic than cimetidine• Famotidine is 20-60 times mov effective. • The antisecretory inluence duration is — 8-10 hours in ranitidine, 12 –
hours in famotidine
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Types Drugs Effectivity
First stage of the eradication treatment
3 component treatment1. IPP2. Amoxillin3. Craritromycin
70-86%1.1. Claritromycin resistancy, 1. IPP2. Amoxillin3. Metronidazole
1.2. Allergy to penicillin 1. IPP2. Claritromycin3. Metronidazole
Second stage of the eradication treatment
Four component treatment
1. IPP2. Bismute
tripotassiumdicitrate3. Metronidazole4. Tetracyclin
76-90%
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Gayneke-Mikulich
pyloroplastic approach
Finney pyloroplastic
approach
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Gastroduodenostomy by Jabuley’s method
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Bilroth 1 and Bilroth 2
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Bilrot -I Bilrot -II
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