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20 Cards in this Set
- Front
- Back
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Peptic Ulcer ??
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ulcer caused by Acid - Pepsin Digestion of mucous membrane
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What are The Common Sites of Peptic Ulcer ?
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1 . Duodenum (commonest)
2 . The lower End of Esophagus 3 . Stomach NB : Less Commonly in jejnum after gastrojejunostomy & in intestine adjacent to meckle's |
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Why The Lesser Curve is the (ulcer Bearing area) ??
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1. Trauma by food
2. Mucosa is less pliable 3. Least vascular area |
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What is The Main Pathology in each of GU & DU ??
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GU . . . defective membrane
DU . . . Hyperacidity |
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what is the ratio (DU:GU) ??
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25 :1
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Etiology of DU ??
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1. Genetic . . LArge Pareital cell mass
2. Increased Vagal Tone 3.Abnormality of Gastrin Release & inhibition 4. Hypergastrenmia 5. H.Pylori 6. NSAID |
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What is Etiology of GU ??
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1. Reflux of bile to stomach
2. Antral stasis 3. H.Pylori 4. NSAIDs 5. ISchemia 6. Trauma by Food |
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How does Bile reflux cause GU ??
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by causing defect in barrier allowing hydrogen ions to diffuse back
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What is Zollinger Ellison syndrome ??
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Hypergastrinemia due to excessive release of gastrin either from hyperplastic Antral cells (type I) or tumor of pancreas (type II)
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What are Investigations you prefer to do for ZES??
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Gastric function tests
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When to suspect Zollinger Ellison syndrome ??
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1. Young Age (Around 20 )
2. Repeated recurrence 3. Diarrhea (due to Jejunal irritation) 4. High Gastrin Level |
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what is ttt of ZES ??
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type 1 . . Partial gastrectomy to remove antral mucosa
type 2 . . .* if tumour seen resection * if not--> H2 antagonist or proton Pump inhibitor |
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What is The aim of treatment in Chronic DU ??
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Reduction of Acidity ONLY
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What is The aim of treatment in Chronic GU ??
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Reduction of acidity & removal of ulcer or removal of the whole ulcer bearing area
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Indications of Surgery in ttt of Chr. DU ??
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1. Failure OF medical
* Relapses * Financial Factors * Poor Pt. Compliance 2. Complications e.g Pyloric stenosis |
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how to acheive reduction of acidity in DU via surgical options ??
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1. Vagotomy :
* Truncal * Selective * Highly Selective * Seromyotomy 2. Other Less preferable options : * Vagotomy + Antrectomy * Subtotal Gastrectomy (Hostorical) |
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In Truncal Vagotomy , what is the % of Acidity reduction ??
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initially 80% that passes to 50%
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Truncal Vagotomy side effects ??
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*** 1. Denervation of pylorus that might be compensated by pyloroplasty
2. denervation of the whole gut except hindgut |
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What are indications of Surgical ttt of Chr. GU ??
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1. Failure of medical :
* failure of healing ***** * suspicious of malignancy * bad pt. Compliance 2. Complications |
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what are surical options to treat GU ??
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1. partial gasterctomy
+ Billroth I . . Gastroduodenal anastmosis OR Bilroth II . . Gastrojejunostomy 2. resection of ulcer + truncal vagotomy 3. resection of ulcer + highly selective vagotomy |
