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Gastric and duodenal ulcer disease. Ulcer disease. ulcer is a defect of gastric or duodenal mucosa which interfere over lamina muscularis mucosae, submucosa or penetrates across whole gastric or duodenal wall rise of ulcer is conditioned by presence of acid gastric content

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ulcer disease
Ulcer disease
  • ulcer is a defect of gastric or duodenal mucosa which interfere over lamina muscularis mucosae, submucosa or penetrates across whole gastric or duodenal wall
  • rise of ulcer is conditioned by presence of acid gastric content
  • frequent disease, men are afected 3-4x more than women
slide3
Pathogenesis:
      • multifactorial
      • dysbalance between protective and aggressive factors
  • Protective f.: saliva, food, alcalic duodenal fluid, mucus - mucine, fast regeneration of gastric epithelial cells, well perfused gastric mucosa
  • Aggressive f.: HCl, pepsin, bile acids (reflux), helicobacter pylori, drugs (analgetics, aspirin, korticoids), nicotine, alcohol
slide4
Classification:

Acute ulcer (ulcus acutum)

      • smooth non-elevated borders and smooth base
      • major bleeding into upper GIT

Chronic ulcer (ulcus chronicum)

      • rushed and elevated boders, inflammation with hypertrophic and fibrotic proliferation is present
      • the most frequent form of ulcer disease
        • Ulcus chronicum mediogastricum
        • Ulcus chronicum ventriculi et duodeni
        • Ulcus chronicum praepyloricum
        • Ulcus chronicum duodeni
slide5
Symptoms of gastric ulcer disease:
    • epigastric pain after meal or during meal
    • upper dyspeptic syndrome – loss of appetite, nauzea, vomiting, flatulence
    • vomiting brings relief
    • reduced nutrition
    • loss of weight
slide6
Symptoms of duodenal ulcer disease:
    • epigastric pain 2 hours after meal or on a empty stomach or during night
    • pyrosis
    • good nutrition
    • obstipation
    • seasonal dependence (spring, autumn)
slide7
Complications:
    • Bleeding - chronic (minor, cause anaemia)

- acute (major, form affected vessel)

    • Perforation - mostly bulbus duodeni, anterior gastricwall

- acute violent pain

- bleeding can be present

    • Penetration- of the ulcer deeply through whole wall into

neighbor organ(pancreas, liver)

    • Stenosis - narrow of thelumencaused by scar, oedema or

inflammatory infiltration after healing of the ulcer

- rise only at pyloric localization

- vomiting of huge volume of gastric content

slide8

Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004

A – penetration B – perforation

C – bleeding D - stenosis

slide9
Therapy:
    • Conservative
      • regular lifestyle
      • prohibition of the smoking and alcohol
      • diet (proteins, milk and milky products)
      • pharmacology (antagonists of H2 receptors, antacids, anticholinergics
    • Surgical
      • BI, BII resection
      • proximal selective vagotomy
      • vagotomy with pyloroplastic
      • suture of perforated or haemorrhagic ulcer
slide10

Stomach resections:

    • Billroth I (BI) – gastro-duodenoanastomosis end-to-end
    • Billroth II (BII) – gastro-jejunoanastomosis end-to-side with blind closure of duodenum
    • Proximalselective vagotomy – denervationof parietal gastric cells
slide13

Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004

Gastro-enteroanastomosis on Roux Y crankle

slide15
Complications after stomach resection:
    • Early – dehiscence, stenosis of anastomosis, bleeding, pancreatitis, obstructive icterus, affection of neighbour tissues
    • Late - days, weeks

- early dumping syndrome

- late dumping syndrome

- incoming crankle syndrome

- outcoming crankle syndrome

- ulcer in anastomosis or in outcoming crankle

slide16
Early dumping syndrome:
    • group of symptoms approved shortly after meal
    • appears after BII resection
    • vasomotoric sy. - face redness, fall of blood pressure, dizziness
    • GI sy. - vomiting, diarrhoea
    • Th.: diet, no sugar, low quantities of food, change BII to BI resection
slide17

Late dumping syndrome:

    • hypoglycaemia(sugar is not enough digested)
    • appears after BII resection
    • weakness, perspiration, dizziness, tremor cca 3h aftermeal
    • Th.: no sugar, change BII to BI resection
slide18

Incoming crankle syndrome:

    • stasis of the content at incoming crankle increase intraluminal pressure
    • appears after BII resection
    • Th.:diet, change BII to BI resection
slide19

Outcoming crankle syndrome:

    • chronic or acute closure of outcoming crankle
    • appears after BII resection
    • vomiting after meal, convulsive pain
    • Th.: change BII to BI resection
benign stomach tumors
Benign stomach tumors
  • rise from all layers of stomach wall
  • often asymptomatic
  • Polypus, Leiomyoma, Lipoma, Fibroma, Neurofibroma, Neurinoma, Hemangioma, Karcinoids, Lymfoma
  • Diagnostic: endoscopy, X – ray
  • Therapy: local excision, stomach resection
slide39

Stomach cancer

  • Symptoms:
    • long-time asymptomatic
    • feeling of full stomach, odour from mouth, tiredness, anaemia, occasional vomiting, loss of appetite, loss of weight
  • Diagnosis:
    • gastrofibroscopy – biopsy - histology
    • X-ray, USG, CT - metastasis
    • Wirchow´s nodule – enlargement of left supraclavicular nodule
stomach cancer
Stomach cancer
  • Etiopathogenesis:
    • Praecancerosis: adenomatous polypus, chronic atrofic gastritis, foveolar hyperplasia (Ménétrier disease), stub of the stomach after BII resection
  • Division:
    • Macroscopic: exofytic polypoid form, diskyform ulcerous form, diffused infiltrating form
    • Histopathologic: adenocarcinoma, papilar, tubular, gelatinous cancer, round cell cancer, flagstone cell cancer, etc.
slide41

Stomach cancer

  • Therapy:
    • Currative – total gastrectomy, sub-total gastrectomy
    • Paliative – gastrostomy, jejunostomy

Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004