Gastric ulcers Flashcards
In which age group are these ulcers most common?
40-70 yeas old
Rare in patients <40 y.o.
How does the incidence in men compare with that of women?
men>women
Which is more common overall: gastric or duodenal ulcers?
Duodenal ulcers are more than twice as common
Think: duodenal=double rate
What is the classic pain response to food?
Food classically increases gastric ulcer pain
What is the cause
Decreased cytoprotection or gastric protection (i.e. decreased bicarbonate/mucous production)
Is gastric acid production high or low?
Gastric acid production is normal or LOW
What gastric ulcers are associated with increased gastric acid?
Prepyloric
Pyloric
Coexist with duodenal ulcers
What are the associated risk factors?
Smoking alcohol burns Trauma CNS tumor/trauma NSAIDS steroids shock
What are the symptoms
Epigastric pain with or without vomiting, anorexia and nausea
How is the diagnosis made?
History, PE
EGD with multiple biopsy ( looking for gastric ulcer)
What is the most common location
~70% are on the lesser cuvature; 5% are on the greater curvature
When and why should biopsy be performed?
With all Gastric ulcers to rule out gastric CA
If the the ulcer does not heal in 6 weeks after medical treatmen, rebiopsy(always biopsy in OR
what is the medical treatment of Gastric ulcers?
Similar to duodenal:
PPIs or H2 blocers, H. pylori treatment
When do patients with gastric ulcers need to have an EGD?
- for dx with biopsies
2. 6 weeks post diagnosis to confirm healing and rule out gastric cancer!
What are the indications for surgery?
The acronym "I CHOP" Intractability Cancer (rule out) Hemorrhage (massive or relentless) Obstruction (gastric outlet obstruction) Perforation
Surgery is indicated if gastric cancer cannot be ruled out
What is the common operation for hemorrhage, obstruction, and perforation?
Distal gastrectomy with excision of the ulcer without vagotomy unless there is duodenal disease (BI or BII)
What are the operations for concomitant duodenal and gastric ulcers?
Resect (BI or BII) and truncal vagotomy
What is a common option for surgical treatment of a pyloric gastric ulcer?
Truncal vagotomoy and antrectomy
What is a common option for a a poor operative candidate with a perforated gastric ulcer?
Graham patach
What must be performed in every operation for gastric ulcers?
Biopsy looking for gastric cancer
PUD/gastritis associated with neurologic trauma/ulcer (THINK:Dr. Cushing = Neurosergeon =CNS)
Cushing’s ulcer
PUD/gastritis associated with major burn injury
Curling’s..Curling iron
Ulcer at the margin of a GI anastomosis
Marginal ulcer
Pinpoint gastric mucosal defect bleeding form and underlying vascular malformation
Dieulafoy’s ulcer
