Laparoscopic surgery of the abdomen. Bruce V.,MacFadyen Jr. Editors: Springer. 2003

The role of endoscopy in the management of patients with peptic ulcer disease Guideline; the American

Society for Gastrointestinal Endoscopy: N 4, 2010;

Institute of Statistics of Republic of Uzbekistan 2013

Spreading of gastric and duodenal ulcer Gender differences

Duodenal ulcer is more prevalent in young males

Gastric ulcer disease occurs more in males after age of 50

Institute of Statistics of Republic Of Uzbekistan 2013

Sceletothopy of the stomach and duodenum

Syntopy of the stomach

Anatomical parts of the stomach

X-ray picture of the stomach

Ligaments of the stomach

Blood circulation of the stomach

Innervation of the stomach

Erosion – superficial defect of the mucous layer

Ulcer - deep defect of the mucous layer

Submucous layer

Muscle layerSerous layer

Mucous layer

Submucous layer

Muscle layer

Mucous layer

Serous layer

Endoscopic picture of the acute and chronic ulcer

Acute ulcer Chronic ulcer

Ulcerogenous factors•Congenital Parietal cells abunancy, nerve system reactivity features; 1- blood group.•Stress hypergastrosis: profession; psychological trauma; burning, sepsis.•Bias of stomach function: Acid- peptic secretion inducing, mucous layer metaplasia•Antroduodenal dysmotoric:

Elevated evacuation, gastrostasis, duodeno-gastral reflux•Food intake regimen violation: Chronic hungriness•Drugs: Aspirin, indometacin, glucocorticoids,•Endocrin influence:

hypoglykemia,, pancreatits; Elisson-Solinger syndrome; Parathyroid adenoma; pituitary adenoma, Adrenal adenoma.•Chronic hepatic diseases (cirrhosis): histamine, gastrin overproduction; mucous content alteration.•Renal diseases: hypergastrinemia, hypercalcinemia, metabolic acidosis; uremic intoxication

Stomach flied

mucous membrane

epithelial cells

Acid neutralization

Damage mucous membrane

Inflammation mucous membrane

Water +

urea

Death of epithelial cells

Defention factors Alteration factors

• Mucous resistancy• Antroduodenal acid buffer

balance• Alkaline secretion• Food

• Pepsin and cloride acid (НСl)

• Gastro-duodenal dismotoric damage

• Mucous injuries

=

Complaints:

Basic:• Epigastral pain

Additional:• Heartburn (pyrosis),• Nausea, vomiting,• Alteration of digestion,• Eructation.

Gastric ulcer Duodenal ulcer

Early: pain occurs only 15-40 minutes after food intake

Late: pain occurs only 2 hours after food intake

Season independent Season dependent: mainly in autumn and spring

Not depended to daytime Night pains (n. vagus), Hungriness pains: ends buffer feature of food

Objective exam:

• Astenic body shape• Alteration of vegetative nerve system: hypotonia, bradycardia, over-perspiration(cold weet feet), visual dermographism (reddish skin color.)

• In the beginning of disease patients eat more than usual (in order to neutralize the gastric acid). Loss of weight consistently.

• White tongue incrustation. • Pain and tenderness at the right upper side of abdomien.

No special symptoms

Generally

Special diagnostic alternatives

Ulcer

Kay histamine probe

1. Aspiration of stomach liquid every 15 minutes during 1 hour.

2. I/m 0,1% histamine injection.

3. Aspiration of stomach liquid every 15 minutes during 1 hour.

4. Assessment of chloride acid concentration in obtained liquid.

Normal basal secretion is 5 mmol/hour , after stimulation– 16 – 25 mmol/hour.

Cholander`s probe

1. Aspiration of stomach liquid every 15 minutes during 1 hour

2. Subcutaneous insulin injection.

3. Aspiration of stomach liquid every 15 minutes during 1 hour.

4. Assessment of chloride acid concentration in obtained liquid.

Cholander probe is positive, only in cases of chloride acid concentration elevation after insulin injection

Differential Diagnostic

•Stomach cancer•Acute and chronic cholecystitis•Acute and chronic pancreatitis•Acute appendicitis

• Ranitidine is less dyspeptic than cimetidine• Famotidine is 20-60 times mov effective. • The antisecretory inluence duration is  — 8-10 hours in ranitidine, 12 –

hours in famotidine

Types Drugs Effectivity

First stage of the eradication treatment

3 component treatment1. IPP2. Amoxillin3. Craritromycin

70-86%1.1. Claritromycin resistancy, 1. IPP2. Amoxillin3. Metronidazole

1.2. Allergy to penicillin 1. IPP2. Claritromycin3. Metronidazole

Second stage of the eradication treatment

Four component treatment

1. IPP2. Bismute

tripotassiumdicitrate3. Metronidazole4. Tetracyclin

76-90%

Gayneke-Mikulich

pyloroplastic approach

Finney pyloroplastic

approach

Gastroduodenostomy by Jabuley’s method

Bilroth 1 and Bilroth 2

Bilrot -I Bilrot -II