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  • Management of Peptic Ulcer

    Încărcat de

    DrArish Mahmood
    383 vizualizări36 pagini
    Peptic ulcers are a circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin. Most often caused by Helicobacter pylori infection. Duodenal sites are 4x as common as gastric sites most common in middle age peak 30-50 years.

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    Peptic ulcers are a circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin. Most often caused by Helicobacter pylori infection. Duodenal sites are 4x as common as gastric sites most common in middle age peak 30-50 years.

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    Attribution Non-Commercial (BY-NC)
    Descărcați ca PPTX, PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    383 vizualizări36 pagini

    Management of Peptic Ulcer

    Încărcat de

    DrArish Mahmood
    Peptic ulcers are a circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin. Most often caused by Helicobacter pylori infection. Duodenal sites are 4x as common as gastric sites most common in middle age peak 30-50 years.

    Drepturi de autor:

    Attribution Non-Commercial (BY-NC)
    Descărcați ca PPTX, PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 36

    m  m

    
    
    
      
    ? 

    A circumscribed ulceration of the


    gastrointestinal mucosa
    occurring in areas exposed to
    acid and pepsin and most often
    caused by Helicobacter pylori
    infection.
    Classification
    r REGION / LOCATION

    x Vtomach (called !  ½


    x ?uodenum (called 2
    2  ½
    x Esophagus (called ë
    !  ½
    x meckel's ?iverticulum (called
    m      ½
    modified Johnson Classification of
    peptic ulcers
    x Type I: Ulcer along the lesser curve of
    stomach
    x Type II: Two ulcers present - one gastric, one
    duodenal/prepyloric
    x Type III: Prepyloric ulcer
    x Type IV: Proximal gastroesophageal ulcer
    x Type V: Anywhere
    ?uodenal Ulcers
    x duodenal sites are 4x as common as gastric sites
    x most common in middle age
    peak 30-50 years
    x male to female ratioȄ4:1
    x Genetic link: 3x more common in 1st degree
    relatives
    x more common in patients with blood group O
    x associated with increased serum pepsinogen
    x H. pylori infection common
    up to 95%
    x smoking is twice as common
    Mastric Ulcers

    x common in late middle age


    incidence increases with age
    x male to female ratioȄ2:1
    x more common in patients with blood group A
    x Use of NVAI?s - associated with a three- to four-fold
    increase in risk of gastric ulcer
    x Less related to H. pylori than duodenal ulcers Ȃ
    about 80%
    x 10 - 20% of patients with a gastric ulcer have a
    concomitant duodenal ulcer
    Comparing ?uodenal
    and Mastric Ulcers
    
    x predisposing factors protective factors
    ü ë 
    ü NVAI?s ü mucus
    ü acid ü bicarbonate
    ü pepsin. ü mucosal blood flow
    ü smoking,
    ü ethanol, ü prostaglandins
    ü bile acids,
    ü aspirin,
    ü steroids
    ü stress.

    Îhen an imbalance occurs, PU? might develop.


    V mPmV

    x PAIN
    x NAUVEA,
    x VOmITING
    x CHEVT ?IVCOm ORT
    x HEmATEmEVIV
    x mELENA
    Complications

    x Perforation & PenetrationȄinto pancreas,


    liver and retroperitoneal space
    x Peritonitis
    x rowel obstruction, Gastric outflow
    obstruction, & Pyloric stenosis
    x rleeding--occurs in 25% to 33% of cases and
    accounts for 25% of ulcer deaths.
    x Gastric CA
    ?ifferential ?iagnosis

    x Neoplasm of the stomach


    x Pancreatitis
    x Pancreatic cancer
    x ?iverticulitis
    x Cholecystitis
    x Gastritis
    x GER?
    x mIȄnot to be missed if having chest pain
     VMV

    1. rAVE LINE INVEVTIGATIONV


    2. H. Pylori can be diagnosed
    a urea breath test
    a blood test(Ig-G½
    a stool antigen assays
    a rapid urease test
    3. GAVTRO-?UO?ENOVCOP WITH rIOPV
    4. Vtool for fecal occult blood.
    5. RA?IOGRAPH WITH rARIUm mEAL

      
      
      
    
    
        
    
     
       
           
     

     
    
      
    Peptic Ulcers:
    Mastric & ?udodenal
    m ?C  m 
    mV  m ?C  m 

    1. TO RELEIVE THE V mPTOmV


    2. TO HEAL THE ULCER
    3. TO PREVENT RECURRENCE
    4. TO PREVENT THE
    COmPLICATIONV
    GENERAL mEAVUREV
     VTOP VmOKING
     VTREVV RE?UCTION
     ?IETAR CHANGE
     AVOI? AVPRIN VTERIO?V NVAI?V ALCOHOL

    ?RUGV
     H-2 RECEPTOR ANTAGONVIVTV
     PROTON PUmP INHIrITORV
     ANTACI?V
     ERA?ICATION THREAP OR H.P ORI
    ?CV  VUMC
     m 
    x I mE?ICAL TREATmENT AILV
    x AN ?OUrT ArOUT HIVTOLOG
    x ULCER IN ANTRUm AN? PREP LORIC R.
    x COmPLICATION
    a P LORIC VTENOVIV
    a HOURGLAVV ?E ORmIT
    a PER ORATION
    a rLEE?ING
    VUM 
    VUMC  m  
    UCmPC ? P PC UC 

    1. rILLROTH I GAVTRECTOm
    2. rILLROTH II GAVTRECTOm
    3. VAGOTOm
    1. TRUNCAL VAGOTOm
    2. HIGHL VELECTIVE VAGOTOm
    4. ?RAINAGE PROCE?URE
    1. GAVTRO JEJUNOVTOm
    2. P LOROPLAVT
    3. ANTRECTOm
    r 
    VUMC  m  
    UCmPC ? P PC UC 

    1. rILLROTH I GAVTRECTOm
    2. rILLROTH II GAVTRECTOm
    3. VAGOTOm
    1. TRUNCAL VAGOTOm
    2. HIGHL VELECTIVE VAGOTOm
    4. ?RAINAGE PROCE?URE
    1. GAVTRO JEJUNOVTOm
    2. P LOROPLAVT
    3. ANTRECTOm
    Mm
    VUMC  m  
    UCmPC ? P PC UC 

    1. rILLROTH I GAVTRECTOm
    2. rILLROTH II GAVTRECTOm
    3. VAGOTOm
    1. TRUNCAL VAGOTOm
    2. HIGHL VELECTIVE VAGOTOm
    4. ?RAINAGE PROCE?URE
    1. GAVTRO JEJUNOVTOm
    2. P LOROPLAVT
    3. ANTRECTOm
    MV  Vm
    VUMC  m  
    UCmPC ? P PC UC 

    1. rILLROTH I GAVTRECTOm
    2. rILLROTH II GAVTRECTOm
    3. VAGOTOm
    1. TRUNCAL VAGOTOm
    2. HIGHL VELECTIVE VAGOTOm
    4. ?RAINAGE PROCE?URE
    1. GAVTRO JEJUNOVTOm
    2. P LOROPLAVT (mikulicz & finny½
    3. ANTRECTOm
    P PV
    VUMC  m  
    UCmPC ? P PC UC 
    1. rILLROTH I GAVTRECTOm
    2. rILLROTH II GAVTRECTOm
    3. VAGOTOm
    1. TRUNCAL VAGOTOm
    2. HIGHL VELECTIVE VAGOTOm
    4. ?RAINAGE PROCE?URE
    1. GAVTRO JEJUNOVTOm
    2. P LOROPLAVT
    3. ANTRECTOm
     Cm
    P  ? MVC UC 
    x CLINICAL ETUREV
    V mPTOmV
    ¦ VEVERE GENERLIZE? Ar?OmINAL PAIN
    ¦ Ar?OmINAL ?IVTENVION
    ¦ VOmETING
    VIGNV
    ¦ EErLE PULVE
    ¦ GENERLIZE? TEN?ERNEVV
    ¦ rOAR? LIKE RIGI?IT
    ¦ RE?UCE? LIVER ?ULLNEVV
     VMV
    x RA?IOGRAPH
    x ?IAGNOVTIC PERITONEAL LAVAGE
    x VERUm Am LAVE
    x CT-VCAN
     m 

    x A AVPIRATION
    x r rLOO? GROUPING
    x C CHARTV
    x ? ?RUGV
    x E EXPLORATIVE LAPROTOm
    x LUI?

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