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    Peptic Ulcer Disease

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    chetankumarbhumireddy
    This document discusses peptic ulcer disease, including the anatomy, physiology, pathophysiology, pathology, classification, complications, investigations, and management. It covers the roles of acid and pepsin secretion, hormones that control gastric secretions, causes of ulcers like H. pylori infection, presentations of acute vs chronic ulcers, complications such as bleeding and perforation, diagnostic tests, and medical and surgical treatment approaches including antibiotics and surgery for ulcers and complications.

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    Peptic Ulcer Disease

    Uploaded by

    chetankumarbhumireddy
    220 views18 pages
    This document discusses peptic ulcer disease, including the anatomy, physiology, pathophysiology, pathology, classification, complications, investigations, and management. It covers the roles of acid and pepsin secretion, hormones that control gastric secretions, causes of ulcers like H. pylori infection, presentations of acute vs chronic ulcers, complications such as bleeding and perforation, diagnostic tests, and medical and surgical treatment approaches including antibiotics and surgery for ulcers and complications.

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    18008011-Peptic-Ulcer-Disease-Ppt

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    This document discusses peptic ulcer disease, including the anatomy, physiology, pathophysiology, pathology, classification, complications, investigations, and management. It covers the roles of acid and pepsin secretion, hormones that control gastric secretions, causes of ulcers like H. pylori infection, presentations of acute vs chronic ulcers, complications such as bleeding and perforation, diagnostic tests, and medical and surgical treatment approaches including antibiotics and surgery for ulcers and complications.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    220 views18 pages

    Peptic Ulcer Disease

    Uploaded by

    chetankumarbhumireddy
    This document discusses peptic ulcer disease, including the anatomy, physiology, pathophysiology, pathology, classification, complications, investigations, and management. It covers the roles of acid and pepsin secretion, hormones that control gastric secretions, causes of ulcers like H. pylori infection, presentations of acute vs chronic ulcers, complications such as bleeding and perforation, diagnostic tests, and medical and surgical treatment approaches including antibiotics and surgery for ulcers and complications.

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    PEPTIC ULCER DISEASE

    (Acid – pepsin ulcer disease)

    G JUMBI
    SURGICAL ANATOMY
    • ANATOMY (Stomach and duodenum)
    -gross anatomy.
    - Microscopic anatomy.
    - Blood supply.
    - Nerve supply.
    PHYSIOLOGY
    GASTRIC SECTRETIONS.
    • THE PARIETAL CELLS (Acid secretion).
    ( The proton pump).
    • THE CHIEF CELLS (Pepsinogens secretion).
    • THE ENDOCRINE CELLS (Hormones secretions). Eg.
    - The G-cells (secretes gastrin hormone) .
    - The D-cells (secretes somatostatin hormone).
    - The ECL-cells eg. Histamine producing cells.
    • THE MUCOUS SECRETING CELLS.
    (COLUMNAR CELLS).
    CONTROL OF GASTRIC
    SECRETIONS.
    • CEPHALIC PHASE (Vagal phase).

    • GASTRIC PHASE (hormonal phase).


    Stimulatory hormones.
    Inhibitory hornones.

    • DUODENAL (INTESTINAL PHASE).


    Stimulatory hormones.
    Inhibitory hormones.
    PATHOPHYSIOLOGY
    (Disorders of control of gastric
    •
    secretion)
    EXCESSIVE ACID/PEPSIN SECRETION
    (Duodenal ulcers).
    • LACK OF MUCOUS PROTECTION.
    (Gastric ulcers).
    • “12 HOUR OVERNIGHT ACID SECRETION TEST”.
    Normal = 10-20 meq/L.
    High acid output = 40-80 meq/L.
    Low acid output = 5-15 meq/L.
    Very high acid output = 100-300 meq/L.
    PATHOLOGY
    • EPIDEMIOLOGY.
    Incidence, Age, Sex, Race, Geographical, Social
    class etc.
    • AETIOLOGY.
    H. pylori, NSAIDs, Alcohol, Smoking, Diet,
    Genetic factors (eg.blood group O),
    Predisposing conditions, Psychosomatic.
    • HELICOBACTER PYLORI.
    DIAGNOSIS - Urease breadth test, Brush
    cytology, Biopsy.
    PATHOLOGY cont.
    • MACROSCOPIC APPEARANCE……CONT.
    ACUTE ULCERS VS. CHRONIC ULCERS.
    SITE, SIZE, SHAPE, EDGES, FLOOR, BASE
    CONSISTENCE, SURROUNDINGS.
    • MICROSCOPIC APPEARANCE.
    ACUTE ULCERS VS. CHRONIC ULCERS.
    DEPTH. INFLAMMATORY REACTION. FIBROSIS.
    • COMPLICATIONS OF PUD.
    ACUTE VS. CHRONIC.
    HAEMORRHAGE,
    PERFORATION & PENETRATION.
    STENOSIS: (OESOPHAGEAL STRICTURE, PYLORIC STENOSIS,
    HOUR-GLASS DEFORMITY,TEA-POT DEFORMITY).
    CLASSIFICATION OF PUD.
    • 1. ACUTE PEPTIC ULCERS.
    NSAIDs, Alcohol, Acute illnesses.
    Superficial. Generalised in location. Small.
    • 2. CHRONIC PEPTIC ULCERS.
    - Duodenal ulcers. Bulbar, post bulbar
    - Gastric ulcers. TYPES I, II, III, IV.
    - Anastomotic (jejunal ulcers).
    - Oesophageal ulcers.
    - Meckel’s.
    Deeper. Ocurrs in Specific locations. Larger.
    COMPLICATIONS OF PUD
    • HAEMORRAGE.
    • Acute ulcers, Chronic ulcers, Penetration.
    • PERFORATION.
    • Acute, Chronic ulcers, Penetration.
    • STENOSIS.
    • Pyloric stenosis,
    • Hour - glass deformity,
    • Tea - pot deformity,
    • Oesophageal stricture.
    MANAGEMENT OF PUD

    OUTLINE OF MANAGEMENT:
    • Hx.
    • P/E.
    • INVESTIGATIONS.
    • TREATMENT
    • SUPORTIVE (COMPLICATED ULCERS).
    • DEFINITIVE (MEDICAL, SURGICAL).
    • COPLICATIONS OF TREATMENT.
    • PROGNOSIS.
    • FOLLOW UP.
    • PREVENTION.
    Mx. CONT.
    DIFFERENTIAL DIGNOSIS
    • UPPER ABDOMINAL PAIN.
    • COMPLICATED ULCERS.
    • HAEMORRHAGE.
    • ACUTE PERFORATION.
    • PYLORIC STENOSIS.
    INVESTIGATIONS
    • STOOL - OCCULT BLOOD.
    • BARIUM MEAL.
    • UPPER GIT. ENDOSCOPY.
    • GASTRIN ASSAY.
    • COMPLICATED PUD
    • PERFORATION – CXR(erect), ABD.(supine de.).
    • HAEMORRAGE – EMERGENCY OGD.
    EMERGENCY ANGIOGRAPHY.
    EMERGENCY RADIO-ISOTOPE SCAN
    TREATMENT OF PUD
    SUPPORTIVE TREATMENT
    (Complicated PUD).
    • HAMORRHAGE.

    • PERFORATION.

    • PYLORIC STENOSIS.

    DEFINITIVE TREATMENT.

    • MEDICAL TREATMENT.

    • SURGICAL TREATMENT.
    DEFINITIVE TREATMENT.
    MEDICAL TREATMENT (TRIPPLERx.)
    CLARITHROMYCIN.
    PPI OR H2RA.

    AMOXICILLIN OR A NITROIMIDAZOLE.

    SURGICAL TREATMENT
    See below
    SURGICAL MANAGEMENT
    • PRE-OPERATIVE MANAGEMENT.
    See below
    • INTRAOPERATIVE MANAGEMENT.
    See below
    • POST-OPERATIVE MANAGEMENT.
    See below
    PRE-OPERATIVE
    MANAGEMENT
    • Investigations.
    • Supportive treatment.
    • Psychological preparation.
    • Preparation of local site of operation.
    • Evaluation for anaesthesia.
    • Informed consent.
    • Premedication.
    SURGICAL TREATMENT
    INTRA-OPERATIVE TREATMENT
    1. OPERATIONS FOR UNCOMPLICATED ULCERS.
    DUODENAL ULCERS – HSV, V&D (SV OR TV)
    GASTRIC ULCERS - PG (BILROTH I OR II) OR V&D.
    2. OPERATIONS FOR COMPLICATED ULCERS
    BLEEDING ULCERS – HAEMOSTASIS + MED. Mx.
    PERFORATED ULCERS – CLOSURE OF
    PERFORATION + MED.Mx.
    OPERATIONS FOR STENOSIS.
    PYLORIC STENOSIS – V&D (GASTRO-JEJUNOSTOMY).
    HOUR-GLASS DEFORMITY – PG.
    TEA-POT DEFORMITY – V&D (GASTRO-JEJUNOSTOMY).
    COMPLICATIONS OF
    TREATMENT
    COMPLICATIONS OF VAGOTOMY.
    • POST-VAGOTOMY DIARRHOEA.
    • DELAYED GASTRIC EMPTYING.
    • “SMALL STOMACH SYNDROME”.
    • EARLY DUMPING SYNDROME
    • GALLSTONES (Truncal Vagotomy).
    COMPLICATIONS OF GASTRECTOMY.
    • DUMPING SYNs (BOTH EARLY & LATE).
    • BILIOUS VOMITTING (AFFERENT LOOP SYN)
    • SMALL STOMACH SYN.
    • NUTRITIONAL DEFFICIENCIES (WT. LOSS, Fe, VIT B12,
    OSTEOPOROSIS).
    • GASTRIC STUMP MALIGNANCY.

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