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Y3R6: Surgery I 👨‍⚕️ > L6: Surgical TTT of Peptic Ulcer > Flashcards

L6: Surgical TTT of Peptic Ulcer Flashcards

1
Q

Indications of Surgery in PU

A
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2
Q

Complications of peptic ulcer disease according to onset

A
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3
Q

Types of Surgeries in Relapsing (Recurrent) DU

A
  • Highly Selective Vagotomy (HSV)
  • total truncal abdominal vagotomy with gastrojejunostomy of mayo or pyloroplasty
  • Vagotomy & Antrectomy
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4
Q

Other Names for Highly Selective Vagotomy (HSV)

A

Called PCV (parietal cell vagotomy) or PGV (proximal gastric vagotomy).

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5
Q

Procedure of Highly Selective Vagotomy (HSV)

A
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6
Q

Advantages of Highly Selective Vagotomy (HSV)

A
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7
Q

Disadvantages of Highly Selective Vagotomy (HSV)

A
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8
Q

What is the most popular and most commonly done operation for peptic ulcer disease?

A
  • total truncal abdominal vagotomy with gastrojejunostomy of mayo or pyloroplasty
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9
Q

But indications for vagotomy and GJ are becoming less and less today.

A

…

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10
Q

Procedure of total truncal abdominal vagotomy with gastrojejunostomy of mayo or pyloroplasty

A
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11
Q

Vagus is …… to stomach and after vagotomy → the motility of the stomach is lost, and gastric stasis occurs.

A
  • secretomotor
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12
Q

…….. GJ is preferred as gravity gives a dependent drainage of the food contents.

A

Posterior

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13
Q

Classically, Criteria of GJ in PU Are …….

A

“Posterior, Vertical, Retrocolic, Isoperistaltic, No loop (short loop), No tension, GJ of Mayo (PVRING)”.

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14
Q

Alternatively, pyloroplasty is preferred by a few surgeons instead of GJ.

A

…

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15
Q

Types of Pyloroplasty

A
  • Heinecke-Mickulicz pyloroplasty
  • Finney pyloroplasty
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16
Q

Procedure of Heinecke-Mickulicz pyloroplasty

A
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17
Q

Complications of Heinecke-Mickulicz pyloroplasty

A
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18
Q

Procedure of Finney pyloroplasty

A
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19
Q

Indications of Finney pyloroplasty

A
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20
Q

Procedure of Vagotomy & Antrectomy

A
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21
Q

Recurrence Rate in Vagotomy & Antrectomy

A

Least (1 %)

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22
Q

Mortality Rate in Vagotomy & Antrectomy

A

3-4%

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23
Q

Types of Surgeries for Persistent Gastric Ulcer

A
  • Billroth I
  • Billroth II
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23
Q

Procedure of Billroth I Partial Gastrectomy

A
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24
Q

RR of Billroth I Partial Gastrectomy

A
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25
Q

MR of Billroth I Partial Gastrectomy

A
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26
Q

what is Billroth II Gastrectomy desribed as?

A

Described as Polya gastrectomy.

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27
Q

Indication of Billroth II Gastrectomy

A
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28
Q

Procedure of Billroth II Gastrectomy

A
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29
Q

HSV With Excison of the Ulcer

A
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30
Q

HSV With Excison of the Ulcer depends on ……

A
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31
Q

Type 4 gastric ulcer

A
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32
Q

Indication of Pauchet procedure

A
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33
Q

Procedure of Pauchet procedure

A
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34
Q

Which Sex is more affected by Perforated Peptic Ulcer?

A
  • More common in males.
  • The Ratio is 8-10 men to woman
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35
Q

Site of Perforated Peptic Ulcer

A
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36
Q

PPT Factors for Perforated Peptic Ulcer

A
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37
Q

Rarely a ‘silent’ ulcer can also perforate (especially those patients treated with cortisone).

A

…

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38
Q

Presentation of Perforated Peptic Ulcer with NSAIDs

A
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39
Q

Presentation of Perforated Peptic Ulcer with H.Pylori

A
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40
Q

Mortality of Perforated Peptic Ulcer

A
  • Perforated peptic ulcers have a mortality rate of 5-10%.
  • Perforated gastric ulcers in the elderly have 20-30% mortality rate.
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41
Q

Golden Time to operate on Perforated Peptic Ulcer

A

within 6 hours.

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42
Q

Onset of Stage Of Chemical Peritonitis

A

2-4 hours from the time of perforation.

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42
Q

GIT Symptoms of Stage Of Chemical Peritonitis

A

There may be an episode of coffee ground vomitus, followed by melaena later.

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43
Q

Stages of duodenal ulcer perforation

A
  • Stage Of Chemical Peritonitis
  • Stage of Reaction
  • Stage of Bacterial Peritonitis
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44
Q

Characters of Pain in Stage Of Chemical Peritonitis

A

Severe agonizing pain.

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45
Q

Site of Pain in Stage Of Chemical Peritonitis

A

In the right hypochondrium.

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46
Q

Timing of Pain in Stage Of Chemical Peritonitis

A

Immediately after the perforation.

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47
Q

Cause of Pain in Stage Of Chemical Peritonitis

A
  • Caused by leakage of gastric and duodenal contents into the ei peritoneal cavity (mainly HCL)
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48
Q

Signs of Shock in Stage Of Chemical Peritonitis

A
  1. The patient is pale and anxious.
  2. Pulse rate: Increased & Blood pressure: may be normal in the initial few hours.
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49
Q

Abdominal Examination in Stage Of Chemical Peritonitis

A
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50
Q

Another Name of Stage of Reaction

A

(also called stage of delusion OR stage of illusion)

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51
Q

Duration of Stage of Reaction

A

This stage lasts for 3-6 hours.

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52
Q

Mechanism of Stage of Reaction

A
  • Chemical irritantion > The peritoneum reacts by secreting peritoneal fluid > HCL and bile are diluted > improvement of symptoms
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53
Q

Signs of Shock in Stage of Reaction

A
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54
Q

Abdominal Examination in Stage of Reaction

A
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55
Q

Mechanism of Stage of Bacterial Peritonitis

A
  • The peritoneal contents get contaminated with gram negative organisms (The organisms are from the intestine itself and not from the peritoneum)
    resulting in bacterial peritonitis.
56
Q

CP of Stage of Bacterial Peritonitis

A
57
Q

Abdominal Examination in Stage of Bacterial Peritonitis

A
  • Gross abdominal distension, guarding, rigidity, abdominal tenderness all over suggest generalized peritonitis.
58
Q

Investigation of perforated duodenal ulcer

A
  • CBC
  • Electrolytes
  • Plain X-Ray Chest or Abdomen
  • CT Scan With Contrast
59
Q

Plain X-Ray Chest or Abdomen in perforated duedenal ulcer

A
60
Q

CT Scan With Contrast in Perforated DU

A
61
Q

Treatment of perforated duodenal ulcer

A
62
Q

Treatment of perforated duodenal ulcer

  • Aspiration of Stomach Contents
A
  • With Ryle’s tube.
  • Aim: to reduce further contamination and to decrease biliary and pancreatic juice.
63
Q

Treatment of perforated duodenal ulcer

  • Blood Grouping & Cross Matching
A

May be necessary for surgery

64
Q

Treatment of perforated duodenal ulcer

  • Charts
A

Temperature, pulse, BP, respiration, urinary output (urinary bladder is catheterized using a Foley’s catheter).

65
Q

Treatment of perforated duodenal ulcer

  • Drugs
A
66
Q

Treatment of perforated duodenal ulcer

  • Exploratory Laparotomy
A
67
Q

Treatment of perforated duodenal ulcer

  • Fluids
A
68
Q

Postoperative follow up in perforated DU

A
69
Q

Surgical options in Perforated DU

A
70
Q

Managment of Early Cases of Perforation

A
71
Q

TTT of subacute abscess in DU

A
72
Q

Haemorrhage from peptic ulcer can be:

A
  • Chronic > anemia
  • Acute > massive hematemesis and melaena.
73
Q

Itis posterior duodenal ulcer that commonly bleeds because it erodes into ……. which runs posterior to the duodenum.

A

gastroduodenal artery

74
Q

A gastric ulcer on lesser curvature erodes into one of branches of …..

A

left or right gastric artery.

75
Q

PPT factors for Hemorrhagic PU

A
76
Q

Characteristics of individuals at an increased risk of developing acute GI bleeding

A
77
Q

History of a patient with Hemorrhagic PU

A
78
Q

CP of Hemorrhagic PU

A
79
Q
  • Perforation produces ……
  • Hemorrhage produces …..
A
  • abdominal signs
  • systemic signs
80
Q

Managmnet of Hemorrhagic PU

A
81
Q

Resuscitation in Hemorrhagic PU

A

Resuscitation is more important than an urgent endoscopy.

82
Q

Emergency Upper Endoscopy in Hemorrhagic PU

A
  • is done to confirm the diagnosis.
  • should be done within 12-24 hours of bleeding depending on condition of the patient
83
Q

Since elderly patients cannot tolerate shock well, decision to control bleeding surgically must be taken early.

A

..

84
Q

if the source cannot be detected due to large clots or massive bleeding, it can be repeated a few hours after a stomach wash and blood transfusion.

A

..

85
Q

Conservative TTT of Hemorrhagic PU

A
86
Q

Non-Surgical TTT of Hemorrhagic PU

A
  • Laser coagulation
  • Sclerotherapy
  • Haemoclip application
  • Bipolar electrocoagulation
87
Q

Effect of Laser coagulation

A

It can arrest the bleeding without direct tissue contact.

88
Q

Types of Laser in Laser coagulation

A
  • Nd YAG laser has been used more commonly because itcan penetrate tissue more Deeply compared to Argon Laser which penetrates very superficial tissues.
89
Q

Success Rate of Laser coagulation

A

Success rate of laser coagulation is around 80%.

89
Q

Components of Sclerotherapy

A
  • Epinephrine (1: 10,000) arrests bleeding by vasoconstriction.
  • 2% ethanolamine, a sclerosant causes dehydration and shrinkage of surrounding tissues.
90
Q

Disadvantages of Sclerotherapy

A

It also produces inflammation and thrombosis of the bleeding vessel.

91
Q

Why is Sclerotherapy the Most Popular Method in TTT of Hemorrhagic PU?

A
  • This is the most popular method Why? e Acheap and easy treatment.
  • The success rate is around 80-90%.
92
Q

Failure of Bipolar electrocoagulation in Hemorrhagic PU

A

Failure rate is 50%

93
Q

Surgical eradication of H. pylori prevents ……

A

rebleeding

94
Q

Surgical TTT of Bleeding PU

A
95
Q

Indications of Bleeding PU

A
96
Q

Endoscopic Prognostic Factors in Bleeding PU

A
97
Q

Role of Surgery in Bleeding PU

A
98
Q

Types of Surgery in Bleeding PU

A
  • Surgery for Bleeding Duedonal Ulcer
  • Surgery for Bleeding Gastric Ulcer
99
Q

Procedure of Surgery in Bleeding DU

A
100
Q

Surgery in Bleeding GU

A
101
Q

Haemostatic methods currently employed include:

A

a) Thermotherapy (heater probe, multipolar or bipolar electrocoagulation).

b) Injection of ethanol or epinephrine solutions.

102
Q

When the bleeding iscontrolled, long-term medical therapy includes:

A

a) Anti secretory agents (usually proton pump inhibitor).

b) Testing for h. Pylori with treatment if positive.

103
Q

If H. pylori is present, documentation of eradication should be performed after therapy.

A

…

104
Q

Old Name of Gastric outlet obstruction

A
  • Earlier it was called pyloric stenosis.
  • However, gastric outlet obstruction is a better word.
105
Q

Site of Gastric outlet obstruction

A

Duodenal OR juxtapyloric.

106
Q

Pathogenesis of Gastric outlet obstruction

A

Chronic cicatrisation (healing by fibrosis) —-> Narrowing of pyloric antrum (which is described as pyloric stenosis).

107
Q

Presentation of Gastric outlet obstruction

A

Usually, the patient present with a long history of duodenal ulcer and a recent Hx of vomiting

108
Q

Causes of Gastric outlet obstruction

In General

A
109
Q

Causes of Benign GOO

A
110
Q

Causes of Malignant GOO

A
111
Q

Pathophysiology of GOO

A
112
Q

Symptoms of GOO

A
113
Q

Pain in GOO

A
114
Q

Signs in GOO

A
  • VGP
  • Succussion Splash
  • Auscultopercussion Test / Auscultoscraping Test
115
Q

Def of Visible Gastric Peristalisis

A
116
Q

Characters of Visible Gastric Peristalisis

A
117
Q

The presence of VGP is diagnostic of pyloric stenosis
(right to left peristalsis is seen in left sided obstructive colonic tumors).

A

…

118
Q

Use of Auscultopercussion / Auscaltoscraping Test

A

To find the greater curvature of the stomach.

119
Q

Succussion Splash in GOO

A
120
Q

If VGP isnot seen, itcan be made prominent by: ….

A
  • Asking the patient to drink at least 500 1000 ml of water (It is difficult. Try and see!).
  • Stimulating the abdomen by flicking movement.
121
Q

Procedure of Auscultopercussion / Auscaltoscraping Test

A
122
Q

Investigations in GOO

A
123
Q

Gastroscopy in GOO

A
124
Q

Barium Meal in GOO

A
125
Q

Electrolytes in GOO

A
126
Q

Intro to TTT in GOO

A
127
Q

TTT of GOO

A
128
Q

Recovery in GOO

A
129
Q

Surgical TTT of GOO

A
130
Q

Surgery is indicated in cases of gastric outlet obstruction in which:

A
  1. there is significant obstruction
  2. medical therapy has failed.
131
Q

The operation usually performed is an ……

A
132
Q

DDx of Pyloric Stenosis

A
133
Q

Compare Between Cicatrised chronic duodenal ulcer & Carcinoma pyloric antrum in terms of

  • Age
  • Duration
  • Appetite
  • Weight Loss
  • Anemia
  • Mass
A
134
Q

The palpable mass is the deciding clinical factor (sign).

A

…

135
Q

Other differences cannot truly differentiate between the two conditions.

A

…

136
Q

Rarely, carcinoma of the stomach is also seen in young patients at the age of 20.

A

…

137
Q

In CHPS, The mass is …..

A

Palpable

138
Q

Done

A

…

Y3R6: Surgery I 👨‍⚕️ (36 decks)

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