Transcript Gastric and duodenal ulcer

Gastric and duodenal
ulcer disease
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
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rise of ulcer is conditioned by presence of acid gastric
content
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frequent disease, men are afected 3-4x more than women
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Pathogenesis:
 multifactorial
 dysbalance
between protective and aggressive factors
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Protective f.: saliva, food, alcalic duodenal fluid, mucus mucine, fast regeneration of gastric epithelial cells, well
perfused gastric mucosa
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Aggressive f.: HCl, pepsin, bile acids (reflux), helicobacter
pylori, drugs (analgetics, aspirin, korticoids), nicotine,
alcohol
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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
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Ulcus chronicum mediogastricum
Ulcus chronicum ventriculi et duodeni
Ulcus chronicum praepyloricum
Ulcus chronicum duodeni
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Symptoms of gastric ulcer disease:
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epigastric pain after meal or during meal
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upper dyspeptic syndrome – loss of appetite, nauzea,
vomiting, flatulence
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vomiting brings relief
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reduced nutrition
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loss of weight
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Symptoms of duodenal ulcer disease:
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epigastric pain 2 hours after meal or on a empty
stomach or during night
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pyrosis

good nutrition

obstipation
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seasonal dependence (spring, autumn)
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Complications:
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Bleeding - chronic (minor, cause anaemia)
- acute (major, form affected vessel)
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Perforation - mostly bulbus duodeni, anterior gastric wall
- acute violent pain
- bleeding can be present
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Penetration - of the ulcer deeply through whole wall into
neighbor organ (pancreas, liver)
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Stenosis - narrow of the lumen caused by scar, oedema or
inflammatory infiltration after healing of the ulcer
- rise only at pyloric localization
- vomiting of huge volume of gastric content
Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004
A – penetration
B – perforation
C – bleeding
D - stenosis
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Therapy:
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Conservative
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regular lifestyle
prohibition of the smoking and alcohol
diet (proteins, milk and milky products)
pharmacology (antagonists of H2 receptors,
antacids, anticholinergics
Surgical
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BI, BII resection
proximal selective vagotomy
vagotomy with pyloroplastic
suture of perforated or haemorrhagic ulcer
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Stomach resections:
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Billroth I (BI) – gastro-duodenoanastomosis end-to-end
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Billroth II (BII) – gastro-jejunoanastomosis end-to-side
with blind closure of duodenum
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Proximal selective vagotomy – denervation of parietal
gastric cells
Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004
Billroth I
Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004
Billroth II
Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004
Gastro-enteroanastomosis on
Roux Y crankle
Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004
Vagotomy
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Complications after stomach resection:
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Early – dehiscence, stenosis of anastomosis, bleeding,
pancreatitis, obstructive icterus, affection of neighbour
tissues
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Late - days, weeks
- early dumping syndrome
- late dumping syndrome
- incoming crankle syndrome
- outcoming crankle syndrome
- ulcer in anastomosis or in outcoming crankle
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Early dumping syndrome:
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group of symptoms approved shortly after meal
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appears after BII resection
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vasomotoric sy. - face redness, fall of blood pressure,
dizziness
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GI sy. - vomiting, diarrhoea
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Th.: diet, no sugar, low quantities of food, change BII
to BI resection
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Late dumping syndrome:
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hypoglycaemia (sugar is not enough digested)
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appears after BII resection
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weakness, perspiration, dizziness, tremor cca 3h after
meal
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Th.: no sugar, change BII to BI resection
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Incoming crankle syndrome:
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stasis of the content at incoming crankle increase
intraluminal pressure
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appears after BII resection
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Th.: diet, change BII to BI resection
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Outcoming crankle syndrome:
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chronic or acute closure of outcoming crankle
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appears after BII resection
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vomiting after meal, convulsive pain
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Th.: change BII to BI resection
Haemorrhagic mediogastric ulcer
Chronic gastric ulcer
Pylorostenosis and gastrectasia
Duodenal ulcer
Stress ulcers
Benign stomach tumors
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rise from all layers of stomach wall
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often asymptomatic
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Polypus, Leiomyoma, Lipoma, Fibroma, Neurofibroma,
Neurinoma, Hemangioma, Karcinoids, Lymfoma
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Diagnostic: endoscopy, X – ray
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Therapy: local excision, stomach resection
Stomach cancer
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Symptoms:
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long-time asymptomatic
feeling of full stomach, odour from mouth, tiredness,
anaemia, occasional vomiting, loss of appetite, loss of
weight
Diagnosis:
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gastrofibroscopy – biopsy - histology
X-ray, USG, CT - metastasis
Wirchow´s nodule – enlargement of left supraclavicular
nodule
Stomach cancer
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Etiopathogenesis:
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Praecancerosis: adenomatous polypus, chronic atrofic
gastritis, foveolar hyperplasia (Ménétrier disease), stub
of the stomach after BII resection
Division:
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Macroscopic: exofytic polypoid form, diskyform
ulcerous form, diffused infiltrating form
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Histopathologic: adenocarcinoma, papilar, tubular,
gelatinous cancer, round cell cancer, flagstone cell
cancer, etc.
Stomach cancer
Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004
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Therapy:
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Currative – total gastrectomy, sub-total gastrectomy
Paliative – gastrostomy, jejunostomy
Gastric cancer
Gastric stub cancer after B II
resection
Schwanoma fundi vetriculi
Than you for your attention!!!