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Surgery > Peptic Ulcer > Flashcards

Peptic Ulcer Flashcards

1
Q

What is peptic ulcer ?

A

Ulcer formation in the upper GI tract that affect lining of stomach “ gastric ulcer ”., duodenum “ duodenal ulcer “ , or lower part of esophagus.
- gastric ulcer : found inside the stomach.
Duodenal ulcer: found inside the duodenum which is the 1st part of the small intestine.

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2
Q

Cause of peptic ulcer disease ?

A
  1. H. pylori ( common cause ). Spirae shape helps bacteria invade the mucosa. Produce urease which break urea which produce ammonia + carbon dioxide = neutralize acid + breaks mucosa.
    - spread from oral oral feco oral.
  2. NSAID usage = decrease prostaglandin ( play role of health of stomach lining ) prostaglandin made us feel pain.
  3. Zollinger - Ellison Syndrome : tumor formation that over secrete gastric = increase stomach acid
  • Smoking, alcohol, genetics increase susceptibility , stress or food ( it doesn’t actually cause it )
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3
Q

Comparison between signs and symptoms of gastric / duodenal ulcer ?

A

Main: Indigestion and Epigastric pain

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4
Q

Diagnosis?

A
  • scope of the stomach ( EGD )
  • upper GI series ( pt drinks barium that will coat upper GI
  • CT scan with contrast
  • H.pylori ; blood test, stool test
    Urea breath test ( pt ingest urea tablet) if H.pylori present break urea into ammonia + carbon dioxide. * breath sample collected to measure CO2 levels.
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5
Q

Complications ?

A
  • GI bleeding
  • Erodes a hole in lining = perforation
  • Bowel blockage @ pylorus from chronic ulceration
  • increase risk of GI cancer
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6
Q

Treatment

A

Meds: PPI, H2 receptor blockers, Antibiotics, anti acid.
Severe cases that causing complications ( vagotemy, pylorolasty, gastric resection )

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7
Q

Intervention

A

Goal ( Assess, moniter, Educate, Administer meds )
1. Assessing : VS bowel = sounds, tenderness, stools / vomit.
2. Ask patient: onset of pain, food help ? ( to differentiate between gastric and deudnal ulcer )
Medication Hx ; med usage ( NSAIDs, Salicylate, corticosteroids, Antiocoagulant )
Family Hx of H.pylori, smoke, drink alcohol or caffeine.

Monitoring : complications of PUD and after surgery
GI bleeding : increase heart rate , decrease BP
Perforation
Peritonitis
Dumbing syndrome

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8
Q

Dumping syndrome

A

Watch after gastric resection
Stomach not able to regulate movement of food..
Happens 15 to 40 mins after eating ( Early dumping )
- Fluid shift cause small bowel distension and increase motility and heart tires to compensate for the sudden shift

S&S : bloating, nausea, diarrhea, hypotension , syncope.

  • 3 hours ( Late dumping ) :
    Food that entered too quickly sm. Intestine rich in carbs / sugar = cause the pancreas to release insulin = hypoglycemia
    S&S : sweating, weak and dizzy .
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9
Q

Patient education

A
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10
Q

Medications for PUD

A

“ Antacid Medications Help Basic Peptic Aliments. “

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11
Q

MODIFIED JOHNSON CLASSIFICATION

A
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12
Q

Type I MODIFIED JOHNSON CLASSIFICATION

A

Lesser curvature ( 60% of gastric ulcers )

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13
Q

Type II MODIFIED JOHNSON CLASSIFICATION

A

Synchronous ulcer in gastric body and duodenum ( most common in first portion )

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14
Q

Type III MODIFIED JOHNSON CLASSIFICATION

A

Prepyrloric

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15
Q

Type IV MODIFIED JOHNSON CLASSIFICATION

A

Near gastroeshageal junction

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16
Q

Type V MODIFIED JOHNSON CLASSIFICATION

A

related to NSAIDs, can be located anywhere, but typically
greater curvature 

17
Q
A

D

18
Q
A

B

19
Q
A

A

20
Q
A

Yellow : benign gastric ulcer
Red : Malignant gastric ulcer

21
Q

The indication for surgery in PUD

A

Medically refractory disease or interactability

22
Q

Urgent / emergency indication of peptic university surgury

A

Perforation
Obstruction
Bleeding

23
Q

The second most common complication of peptic ulcer

A

Perforated peptic ulcer

24
Q

Clinical features of perforated peptic ulcer

A

Acute onset of sharp Abdul pain
Approximately 1/3 of patients have a history of peptic UD
On physical exam
The patient will be lying motionless
The abdomen does not move with respiration
Abdominal rigidity ( board like rigidity )

25
Q

Work up of perforated peptic ulcer ( Lab)

A

CBC ( leukocytosis with a left shift )
Blood chemistries decreased albumin, and elevated BUN and
creatinine.
CRP
Amylase and lipase to exclude pancreatitis

26
Q

Radiography of Perforated PUD

A
27
Q

Treatment of perforated PUD

A

Adequate volume resuscitation
Broad spectrum IV Abx
Adequate analgesia
Intravenous PPI

28
Q

The patient is hemodynaomic instable and perforated > 24 hours and had duodenal ulcer, how would you manage him surgically?

A

Simple omental patch closure and abdominal lavage

29
Q

The patient is hemodynaomic stable and perforated < 24 hours and had duodenal ulcer, how would you manage him surgically?

A

Omental patch + Highly selective vagotomy
Or
Patch + truncal vagotomy and drainage

30
Q

Patient is stable with no multiple operative risk factors and on Type 2 , 3 gastric ulcers, how would manage him surgically?

A

Distal gastrectomy +Vagotomy

31
Q

Unstable patient or high risk patient gastric ulcer , how would you manage him surgically ?

A

Wedge excision, vagotomy and drainage

32
Q

Artery of hge in bleeding PUD

A

Gastriduodenal artery

33
Q

Operation for bleeding peptic ulcer ( hemodynamically unstable or high operative risk )

A
34
Q

Stable patient with low operative risk ( bleeding )

A
35
Q

Types of obstruction

A

Acute obstruction:
- Caused by edema and dysmotility
• Chronic obstruction:
- Due to scar formation

36
Q

Clincal presentation

A

Nausea • Nonbilious vomiting • Epigastric pain and distension • Weight loss
Physical examination:
• The patient appear unwell and dehydrated
Abdominal examination:
- Distended stomach and a succussion splash may be audible
• We should examine for jaundice and adenopathy

37
Q

Management of acute obstruction

A

Rehydration with intravenous isotonic saline + potassium • NPO • Nasogastric suction • Maintain input/output charts • IV PPIs

38
Q

Management of chronic obstruction

A
39
Q

Intractable Duodenal Ulcers D.D

A

Surgery (14 decks)

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