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Duodenal ulcer

Terms in this set (20)

descripe duodenal ulcer
a tye of peptic ulcer disease that is more common than gastric ulcers.
typically in age 25-30
what is duodenal ulcer associated with
smoking
alcholo
NSAIDs
H.pylori (85%)
clinical feature
cyclical pain develops 1-3h after meal
hunger pain and central back pain
pain is relieved by eating or anatacids
nausea and epigastric pain (gnawing burning sensation)
periods of pain over weeks and then periods of remission
treatment of duodenal ulcer
medical
surgical
medical treatment of duodenal ulcer?
tripple thearpy : metrondiazole,PPI,clarithromycin
reduced alcohol intakes
stop nsaids
PPI and antacids
descirbe surgical treatment of duodenal ulcer
rarely indicated with the effective acid reducing medications.
used only if complications arise of med.trt fails
type II partial gastrectomy for duodenal ulcers (bilroth 2)'
complicaions of duodenal ulcer
perforation
hemorrhage
gastric outlet obstruction
descirbe perforated ulcer
anterior: sudden onset of pain,acute abdomen,rigid diffuse guarding, chemical periotonitis followerd by bacterial periotonits.
ingestigations of anterior perforated ulcer
chest x ray,usually free air under diaphragm. 70% of patients.
treatment of perforated ulcer
oversew ulcer (plication) and omental (graham) patch
clinical feature and diagnosis of posterior perforated ulcer
constant,mid epigastric pain, radiating to the back.pain is unreleated to mealds.
-elevated pacnreatic lipase/amylase
describe hemorrhage as a complication of duodenal ulcer
typically with posterior perforation and involvement of gastroduodenal artery.
treatment of hemorrhage as a complications of duodenal ulcer
resuscitation with crystalloids and blood if required
endoscopy : laser,cauterisation or injection
surgery if endoscopy fails or rebleed. oversewing or pyloroplasty
describe gastric outlet obstruction
ulcer can lead to edema and fibrosis of the pyloric channel.
clinical feature of gastric outlet obstruction
nasuea and vomiting (undigested food,non bilous)
dilated stomach
crampy abdominal pain
suction splash when patient is shakec.
treatment of gastric outlet obstruction
high dose PPI treatment
NG decompression and correction of hypochloremic,hypokalemic metabolic alkalosis.
if obstruction does no resolve,consider surgical resection:
bilroth 1
pyloroplasty
gastrojejunostomy to bypass
investigations in duoedan ulcers
gastroscopy : most common : most ulcers occur in the duodenal bulb.
urease testing : h.pylori
fastin serum gastrin levels : if hypergastrinemia is sucpected
what is gastroduodenectomy
removal of part of the stomach and anastemosis with duodenum or jejenum
-Bilroth 1
-bilroth 2
describe bilroth 1
Gastoduodenosomy : stomach connected with duodenum
descrobe bilroth 2:
gasto jejunostomy : stomach connected with jejenun
more complicted
leakage
anastamosis leakage
bleeding
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