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Gastric and duodenal ulcer disease. Ulcer disease ulcer is a defect of gastric or duodenal mucosa which interfere over lamina muscularis mucosae, submucosa.

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Presentation on theme: "Gastric and duodenal ulcer disease. Ulcer disease ulcer is a defect of gastric or duodenal mucosa which interfere over lamina muscularis mucosae, submucosa."— Presentation transcript:

1 Gastric and duodenal ulcer disease

2 Ulcer disease ulcer is a defect of gastric or duodenal mucosa which interfere over lamina muscularis mucosae, submucosa or penetrates across whole gastric or duodenal wall ulcer is a defect of gastric or duodenal mucosa which interfere over lamina muscularis mucosae, submucosa or penetrates across whole gastric or duodenal wall rise of ulcer is conditioned by presence of acid gastric content rise of ulcer is conditioned by presence of acid gastric content frequent disease, men are afected 3-4x more than women frequent disease, men are afected 3-4x more than women

3 Pathogenesis: Pathogenesis:  multifactorial  dysbalance between protective and aggressive factors - Protective f.: saliva, food, alcalic duodenal fluid, mucus - mucine, fast regeneration of gastric epithelial cells, well perfused gastric mucosa - Aggressive f.: HCl, pepsin, bile acids (reflux), helicobacter pylori, drugs (analgetics, aspirin, korticoids), nicotine, alcohol

4 Classification: Classification: Acute ulcer (ulcus acutum)  smooth non-elevated borders and smooth base  major bleeding into upper GIT Chronic ulcer (ulcus chronicum)  rushed and elevated boders, inflammation with hypertrophic and fibrotic proliferation is present  the most frequent form of ulcer disease Ulcus chronicum mediogastricum Ulcus chronicum mediogastricum Ulcus chronicum ventriculi et duodeni Ulcus chronicum ventriculi et duodeni Ulcus chronicum praepyloricum Ulcus chronicum praepyloricum Ulcus chronicum duodeni Ulcus chronicum duodeni

5 Symptoms of gastric ulcer disease: Symptoms of gastric ulcer disease:  epigastric pain after meal or during meal  upper dyspeptic syndrome – loss of appetite, nauzea, vomiting, flatulence  vomiting brings relief  reduced nutrition  loss of weight

6 Symptoms of duodenal ulcer disease: Symptoms of duodenal ulcer disease:  epigastric pain 2 hours after meal or on a empty stomach or during night  pyrosis  good nutrition  obstipation  seasonal dependence (spring, autumn)

7 Complications: Complications:  Bleeding - chronic (minor, cause anaemia) - acute (major, form affected vessel) - acute (major, form affected vessel)  Perforation - mostly bulbus duodeni, anterior gastric wall - acute violent pain - acute violent pain - bleeding can be present - bleeding can be present  Penetration - of the ulcer deeply through whole wall into neighbor organ (pancreas, liver) neighbor organ (pancreas, liver)  Stenosis - narrow of the lumen caused by scar, oedema or inflammatory infiltration after healing of the ulcer inflammatory infiltration after healing of the ulcer - rise only at pyloric localization - rise only at pyloric localization - vomiting of huge volume of gastric content - vomiting of huge volume of gastric content

8 Zeman, M. et al., Speciální chirurgie, ISBN , 2004 A – penetrationB – perforation C – bleedingD - stenosis

9 Therapy: Therapy:  Conservative regular lifestyle regular lifestyle prohibition of the smoking and alcohol prohibition of the smoking and alcohol diet (proteins, milk and milky products) diet (proteins, milk and milky products) pharmacology (antagonists of H2 receptors, antacids, anticholinergics pharmacology (antagonists of H2 receptors, antacids, anticholinergics  Surgical BI, BII resection BI, BII resection proximal selective vagotomy proximal selective vagotomy vagotomy with pyloroplastic vagotomy with pyloroplastic suture of perforated or haemorrhagic ulcer suture of perforated or haemorrhagic ulcer

10 Stomach resections: Stomach resections:  Billroth I (BI) – gastro-duodenoanastomosis end-to-end  Billroth II (BII) – gastro-jejunoanastomosis end-to-side with blind closure of duodenum  Proximal selective vagotomy – denervation of parietal gastric cells

11 Zeman, M. et al., Speciální chirurgie, ISBN , 2004 Billroth I

12 Billroth II Zeman, M. et al., Speciální chirurgie, ISBN , 2004

13 Gastro-enteroanastomosis on Roux Y crankle

14 Zeman, M. et al., Speciální chirurgie, ISBN , 2004 Vagotomy

15 Complications after stomach resection: Complications after stomach resection:  Early – dehiscence, stenosis of anastomosis, bleeding, pancreatitis, obstructive icterus, affection of neighbour tissues  Late - days, weeks - early dumping syndrome - early dumping syndrome - late dumping syndrome - late dumping syndrome - incoming crankle syndrome - incoming crankle syndrome - outcoming crankle syndrome - outcoming crankle syndrome - ulcer in anastomosis or in outcoming crankle - ulcer in anastomosis or in outcoming crankle

16 Early dumping syndrome: Early dumping syndrome:  group of symptoms approved shortly after meal  appears after BII resection  vasomotoric sy. - face redness, fall of blood pressure, dizziness  GI sy. - vomiting, diarrhoea  Th.: diet, no sugar, low quantities of food, change BII to BI resection

17 Late dumping syndrome: Late dumping syndrome:  hypoglycaemia (sugar is not enough digested)  appears after BII resection  weakness, perspiration, dizziness, tremor cca 3h after meal  Th.: no sugar, change BII to BI resection

18 Incoming crankle syndrome: Incoming crankle syndrome:  stasis of the content at incoming crankle increase intraluminal pressure  appears after BII resection  Th.: diet, change BII to BI resection

19 Outcoming crankle syndrome: Outcoming crankle syndrome:  chronic or acute closure of outcoming crankle  appears after BII resection  vomiting after meal, convulsive pain  Th.: change BII to BI resection

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25 Haemorrhagic mediogastric ulcer

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27 Chronic gastric ulcer

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34 Pylorostenosis and gastrectasia

35 Duodenal ulcer

36 Stress ulcers

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38 Benign stomach tumors rise from all layers of stomach wall rise from all layers of stomach wall often asymptomatic often asymptomatic Polypus, Leiomyoma, Lipoma, Fibroma, Neurofibroma, Neurinoma, Hemangioma, Karcinoids, Lymfoma Polypus, Leiomyoma, Lipoma, Fibroma, Neurofibroma, Neurinoma, Hemangioma, Karcinoids, Lymfoma Diagnostic: endoscopy, X – ray Diagnostic: endoscopy, X – ray Therapy: local excision, stomach resection Therapy: local excision, stomach resection

39 Symptoms: Symptoms:  long-time asymptomatic  feeling of full stomach, odour from mouth, tiredness, anaemia, occasional vomiting, loss of appetite, loss of weight Diagnosis: Diagnosis:  gastrofibroscopy – biopsy - histology  X-ray, USG, CT - metastasis  Wirchow´s nodule – enlargement of left supraclavicular nodule Stomach cancer

40 Etiopathogenesis: Etiopathogenesis:  Praecancerosis: adenomatous polypus, chronic atrofic gastritis, foveolar hyperplasia (Ménétrier disease), stub of the stomach after BII resection Division: Division:  Macroscopic: exofytic polypoid form, diskyform ulcerous form, diffused infiltrating form  Histopathologic: adenocarcinoma, papilar, tubular, gelatinous cancer, round cell cancer, flagstone cell cancer, etc.

41 Therapy: Therapy:  Currative – total gastrectomy, sub-total gastrectomy  Paliative – gastrostomy, jejunostomy Stomach cancer Zeman, M. et al., Speciální chirurgie, ISBN , 2004

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49 Gastric cancer

50 Gastric stub cancer after B II resection

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52 Schwanoma fundi vetriculi

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56 Than you for your attention!!!


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