Sie sind auf Seite 1von 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?