COMLLICATIONS OF CHRONIC PEPTIC ULCER By AMGAD FOUAD
COMLLICATIONS OF CHRONIC PEPTIC ULCER By AMGAD FOUAD Professor Of Surgery Gastroenterology Center Mansoura University.
1. Perforation - Acute - Subacute - Chronic 2. Bleeding - Hematemsis - Melena - Both 3. Stenosis - pyloric stenosis - Hourglass 4. Malignanacy -Tea-pot
ACUTE PERFORATION Incidence Ø 10 – 15 % Ø DU>GU 10 times Etiology Ppt alcohol Irritant foods nervousness Path Ant >post wall Ø Stages : Stage of perforation stage of reaction stage of peritonitis
C/P q Hist : +ve in 80 % q Manifestations : 3 stages 1. STAGE OF ONSET Ø Sudden severe agonising pain Ø Shock 2. LUCID INTERVAL: Ø 3 – 6 h Ø Patient feels & looks better Ø Tenderness & rigidity remain. 3. SEPTIC PERITONITIS: Ø 6 hours Ø Abdomen distended & silent Ø 36 – 48 hours → Toxemia
INVESTIGATIONS Clinical Hist → Diagnostic Ø Doubtful Cases ü Plain X ray (70 %) ü GIT series with water-soluble contrast TREATMENT 1. Resuscitation 2. Urgent surgical intervention (Graham patch). 3. Definitive surgery Ø
Subacute Perforation A small leaking ulcer allow the body to wall off leaking material from the general cavity by omentum or by the liver with development of Subphrenic abcess
Chronic perforation (penetrating ulcer) The ulcer base penetrates a nearby organ ü Liver ü Pancreas ü Transverse colon
BLEEDING PEPTIC ULCER Incidence : 65% DU > GU Hematemsis → GU Melena → DU Pathology : Mild : Granulation tissue Severe: Vs at floor Fatal : Penetration of large extragastric artery
Clinical picture: ØLong history ØMassive bleeding Hypovolemic shock Hematemsis Melena ØUnless bleeding stops within 48 h → irreversible shock Investigations: ØFiberoptic endoscopy ØSelective celiac angiography.
TREATMENT Conservative: Ø Resuscitation Ø Diagnosis Ø Subsequent management Surgical: Ø Indication: üProfuse bleeding üage > 45 years. üAssociated pathology procedure : Ø Aim→ stop bleeding Ø DU → vagotomy & drainage & under – running Ø GU → Partial gastrectomy Endoscopic: Ø Laser Ø Sclerotherapy Ø V. C agents
PYLORIC STENOSIS (GASTRIC OUTLET OBSTRUCTION) Pathology: Duod bulb → Cicatrized & stenosed Stomach → Hypertrophied → Dilated Intestine →Normal & Collapsed Complications: Metabolic Alkalosis Fluid & electrolyte imbalance Dehydration Antral Stasis Respiratory complications
CLINICAL PICTURE Ø Long history: Ø Symptoms: Distention Pain Vomiting Lost periodicity Progressive constipation Picture of complications Ø Signs: General → Dehydration → Tetany → Mental confusion Abdominal → Epigastric fullness → Visible peristaltic waves → Succussion splash → Food residue
INVESTIGATIONS Ø Blood chemistry Ø Gastric function tests Ø Ba Meal (soup dish appearance) Ø Endoscopy.
TREATMENT Pre-operative preparation: Gastric lavage IV fluid Abx Surgery: The only method of cure Vagotomy & drainage Gastrectomy
Thank you
- Slides: 16