Stomach and duodenum
This presentation is the property of its rightful owner.
Sponsored Links
1 / 34

STOMACH AND DUODENUM PowerPoint PPT Presentation


  • 120 Views
  • Uploaded on
  • Presentation posted in: General

STOMACH AND DUODENUM. Begashaw m (MD). Introduction. PUD is a common problem Helicobacter pylori (H. pylori) - important associated risk factor Gastric cancer -One of the top five cancers -Worst prognosis - difficulty to diagnose -High index of suspicion.

Download Presentation

STOMACH AND DUODENUM

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Stomach and duodenum

STOMACH AND DUODENUM

Begashaw m (MD)


Introduction

Introduction

  • PUD is a common problem

  • Helicobacter pylori (H. pylori) - important associated risk factor

  • Gastric cancer

    -One of the top five cancers

    -Worst prognosis - difficulty to diagnose

    -High index of suspicion


Stomach anatomy

Stomach Anatomy

  • Asymmetric dilation of the proximal gastro intestinal tract

  • Capacity-1.5 to 2.0 L

  • Cardia, Fundus, Body, Antrum& Pylorus

  • Pyloric sphincter- regulates gastric emptying & prevents reflux

  • Wall - Four layers Mucosa, Submucosa, Muscularis & Serosa


Anatomy

Anatomy


Types of cells secretion

Types of cells & secretion


Functions

Functions

A-Food breakdown to form chyme

- mechanical digestion and

- acid and pepsin action

B-Reservoir through receptive relaxation

  • Phases of gastric secretion

    _Cephalic - Acetylcholin by the vagusnerve

    _Gastric - Gastrin(by G cells)

    _Intestinal - mainly inhibitory - Secretin


Histology

Histology

  • Surface epithelial cells alkaline mucus

  • Mucus cells_mucus, HCO3¯

  • Parietal cellsHCl, Intrinsic factor

  • Chief cellspepsinogens, lipases


Pathogenesis

Pathogenesis

imbalance in aggressive activity of acid & pepsin & defensive mechanisms

Factors

1. Helicobacter pylori

2. NSAIDs - aspirin

3. Acid hypersecretion

4. Rapid gastric emptying

5. Impaired duodenal acid disposal

6. Impaired gastric mucosal defense

7. Duodenogastric reflux


Classification

Classification

Erosive gastritis

Acute gastritis - after major trauma, shock, sepsis, head Injury & ingestion of aspirin & alcohol -“Stress erosion”

Chronic gastritis->Established inflammatory reaction


Stomach and duodenum

Duodenal ulcer -occurs in the proximal duodenum with in 1 to 2 cm of the pylorus & there is acid hyper secretion

Gastric ulcer_ acid secretion is either normal or decreased


Classification1

Classification


Summary of clinical features

Summary of clinical features


Investigations

Investigations

A- Gastroduodenoscopy and biopsy

B- Barium meal

C- Blood studies ↓ hemoglobin (Hgb) shows chronic blood loss

D-H.pyloritest


Treatment

Treatment

  • Medical treatment

  • Acid reduction

    - H2 – receptor antagonists– cimetidine 800 mg/night for 6 wks

    - Proton pump inhibitor – omeprazole 20 mg/day

    - Irritants_avoid

  • Anti H. pylori treatment

    -Bismuth tablets

    -Amoxicillin for 2 – 4 weeks

    -Metronidazole


Surgical treatment

Surgical treatment

A - Complications

– obstruction

_ perforation

_ bleeding

B - Intractability


Complications of pud

Complications of PUD


Perforated peptic ulcer

Perforated peptic ulcer

- Sex ratio 2:1 , age 45-55 years

- Anterior surface of duodenum (location)

- Past history of PUD is common

- Gastric contents spill over the peritoneum and bring about peritonism which will be followed by bacterial peritonitis after 6 hours


Clinical features

Clinical features

Sudden onset of abdominal pain

Pale, anxious

Raised pulse rate

Abdomen still, not moving with respiration tender, board like rigidity

After 6 hrs peritonitis - silent abdominal distention

Erect plain abdominal x-ray/CXR - air under diaphragm


Air under diaphragm

Air under diaphragm


Treatment1

Treatment

Resuscitate

Antibiotic therapy

Continuous gastric aspiration

Urgent laparotomy- peritoneal toilet and closure of perforation with omentalpatch

Anti H-pylori treatment - recurrence


Omental patch

Omental patch


Graham patch technique

Graham patch technique


Bleeding peptic ulcer

Bleeding Peptic Ulcer

- Slight bleeding -trauma from solid food

- Severe hemorrhage - erosion of an artery at the base of the ulcer located posteriorly(gastoduodenal, splenic)

- Patient presents with hematemesis and/or melena


Management

Management

  • Conservative

    - IV fluid resuscitation

    - Blood transfusion if indicated

    - Naso gastric tube insertion and saline lavage

    - H2 receptor antagonist

    - Endoscopic evaluation

    - Serial hematocrit


Gastric outlet obstruction goo

Gastric Outlet Obstruction-GOO

results from cicatrisation and fibrosis due to long standing duodenal or juxtapyloric ulcer

Clinical feature

- pain, fullness, vomiting of large foul smelling vomit

- peristaltic wave from left to right

- succussionsplash

- electrolyte disturbance and metabolic alkalosis

- Barium meal-large stomach full of food residue with delay in evacuation


Treatment2

Treatment

Surgery – truncalvagotomy and bypass operation after preliminary gastric lavage with saline for 4-5 days

Correction of fluid and electrolytes using crystalloid fluids


Gastric cancer

Gastric Cancer

Epidemiology

- Age 40-60 years

- Sex M:F 3:1

More common in Far East – Japan

Etiology

Premalignant conditions

Risk factors:

Gastric polyp,pernicious anemia, post gastrectomystomach, gastritis, cigarette smoking

& genetic makeup


Stomach and duodenum

Pathology

- Prepyloricregion is the most common site

- Microscopic - Adenocarcinoma

Spread

-Direct

-lymphatic

-transperitoneal

-blood stream


Clinical features1

Clinical features

New onset dyspepsia -above 40 yrs

Anorexia ,loss of weight

Anemia, tiredness, weakness, pallor

Persistent pain with no response to medical treatment

Gastric distention

Dysphagiaor fullness, belching , vomiting

Other signs

- Virchow’s nodes , Krukenbergtumor

- Abdominal mass

- Ascites


Gastric ca

Gastric ca


Investigations1

Investigations

- Gastroscopy and biopsy

- Hgb

- Barium meal shows filling defect

- Laparotomy (diagnostic)


Stomach and duodenum

Treatment

- Gastrectomy when possible

- Palliative bypass surgery

Prognosis

- Over all 5 years survival is about 10 -20%


  • Login