Pud Flashcards
Name 4 possibly outcomes of h pylori infection
Gastritis 100% of patients but asymptomatic
Peptic ulcer in 15%
Gastric malignancy; gastric carcinoma and mucosal associated lymphomatous tissue MALT Lymphoma
Asymptomatic
What are the investigations of choice for a patient suspected for hpulori induced pud
Upper GI contrast studies: barium meal shows barium in crater of ulcer
Single contrast:50% of ulcers
Double contrast:80-90% of ulcers
Malignancy suggested if ulcer is: elevated, more than 2cm, heaped up edges, no ass duodenal ulcer
Upper GI endoscopy: allows for biopsy and therapeutic in setting of GI bleed
Must perform FOUR quadrant biopsy on all gastric ulcer to rule out malignancy
Non invasive measures of diagnosing h pylori infections
C-urea breath test (affected by ppi so false negatives)(method to show eradication)
Serology (can remain positive after treatment)remains elevated up to a year
Stool antigen test (better for acute infection)
Describe triple therapy for h pylori eradication
Amoxicillin
Clarithromycin
Ppi bid eg lansoprazole
Quadruple therapy for h pylori
Tetracycline
Metronidazole
Ppi
Bismuth subsalicylate
Surgical options for management of pud
Vagotomy: surgical division of anterior and posterior vagal trunk of vagus nerve(truncal vagotomy)
Denvervation results in 70% decrease in acid production
However complication of this is delayed gastric emptying, postvagotomy diarrhea, postvagotomy hypergastrinemia
So done with pyloroplasty(reduce gastric stasis)
Antrectomy(remove gastric producing cells)
Subtotal gastrectomy
Describe bilroth 1 vs bilroth 2
1: distal gastrectomy with end to end or side to side gastroduodenostomy
2: resection of distal 2/3 of stomach with blind ending duodenal stump and end to side gastrojejunostomy
With the control of hemorrhage from a Pud, what are emergency control methods
Oversewing - use 2/0 synthetic absorbable suture
For larger perforations:
Graham patch repair- plication of ulcer and omental patch
Antrectomy and bilroth 2
