GASTER, DUODENUM, AND PANCREAS Dr. Sigid djuniawan,spB

PEPTIC ULCER & DUODENAL ULCER Corrosive action in oesophagus, duodenum, stomach, jejunum, ileum 2% adult in USA Men :women = 3 :1 Sign and symptom : pain, bleeding, perforation, obstruction (pylorus, gastroesophageal junction) Therapy ; somatostatin,antasida, H2 antagonis, antibiotic, surgical (ligation, vagotomi+piloroplasti, gastrektomi; indication : malinancy –prepyloric in major curve, indolence in posterior) Complication : perforation (10%) DUODENAL ULCER Epigastric pain relieved by food or antacid Epigastric tenderness Normal or increased gastric acid secretion Sign of ulcer disease on upper git Evidence of H pylori infection Young and midle age (20-45) , men> women 95% within 2 cm pylorus in the duodenal bulb Complication : hemorrhage, perforation, duodenal obstruction Surgical : vagotomy truncal, antrectomy plus vagotomy, subtotal gastectomy

Complication of surgery Early : leakage, gastric retention, hemorrhage Late : reccurent ulcer, fistula gastrojejunocolic and gastrocolic Dumping syndome (after eating : palpitations, sweating, dyspnea, flushing, nausea, abdominal cramps, vomiting, diare, syncope) Alkaline gastritis Anemia Chronic gastropharesis Zollinger-Ellison syndrome Gastric acis hypersecretion by gastrinoma (pancreas, duodenum, antrum) Treatment : H2 blocking agent, resection

Gastric carcinoma 20.000 new cases in USA H pylori infection Male > female, 50-70 yo, low economy, blood A Predisposition : Low disetary vegetables and fruits, high intake starches, salt, chronic ulcus in gaster,salting fish Mean age 60 yo, rare < 40 yo Adenocarcinoma (HPA : intestinal type, diffus type) 40% in antrum, lesser curve, 30% fundus, 25% cardia Clinical : abdominal discomfort after meal, anorexia, weight loss, anemia Lab : anemia, CEA >, usg endoscopy, CT, Sitology gaster fluid Metastatic : early and spreading (limfogen : st Mary Yoseph’s node, Virchow’s node, Troisier sign) , hematogen,ovarial (krukenberg’s tumour), adjascent structure (rare) Imaging ; gastroscopy and biopsy Early : mucous and submucous, Japanese endoscopy (proliferant, superficial, ulcerating) Advance : (Borrmann) fungating, excavated, ulcerated-infiltratif, scirrhous –linitis plastica/ diffused thickened Morfolgy : fungating, malignant ulcus, infltrating Treatment : curative treatment (surgical resection), 85% operable, reconstruction by bilroth I dan II, total gastrectomy and splenectomy, Paliatif : gastrostomy, enterostomy

Complication after surgery : early : acute dilatation, stoma obstruction, leakage late ; dumping syndrome, diarhea, gastritis, obstruction, marginal peptic ulcer

Duodenum Duodenal diverticula Duodenal tumors Adenocarcinoma, leiomyosarcomas, lymphomas Descending duodenum Pain, obstruction, bleeding, obstructive jaundice, abdominal mass Endoscopy and biopsy therapy : resected, pancreaticoduodenectomy Unresectable  radiotherapy