Peptic ulcer disease презентация

Ulcerogenic Factors
Nonspecific
Endogenous :
Hyper secretion of HCl and pepsin
H. pylori
Chronic gastritis “B” and metaplasia into duodenal mucosa
Failure of gastroduodenal movement
Genetic susceptibility

Pathophysiology of peptic ulcer disease
Abnormalities in the secretion of gastric acid and pepsin,and on the suppression of acid as a treatment strategy.
Gastric hypersecretion-associated with gastrinoma in Zollinger-Ellision syndrome,antral G-cell hyperplasia,an increase in parietal-cell mass and physiological imbalance between the antagonistic gastric hormones gastrin and somatostatin-is still an important issue in peptic ulcer disease.

Management and Prevention of NSAID-associated peptic ulcer
Misoprostol, a mucosal-protective analogue of prostaglandin E2 reduces the risk if ulcer complications,but only at the recommended dose of 800 ug/day.
Lower doses of misoprostol are not effective

А.А. Shalimov, V.V. Sajenko, 1972, 1987.
Direct indications:
Perforation of ulcer.
Decompensating pyloroduodenal stenosis.
Profuse GIT bleeding.
2. Indirect indications:
Penetration into contiguous organs.
Giant ulcer.
Recurrence bleeding.
Long –term medical history with recurrences of ulcer
Unsuccessful drugs therapy .
Indirect indications are changeable according trials.

Perforation of ulcer;
Decompensating pyloroduodenal stenosis;
Profuse GIT bleeding after unsuccessful endo-hemostasis;
Penetration into contiguous organs;
Recurrence bleeding;
Long –term medical history with recurrences of ulcer with unsuccessful drug therapy.
According to our experience indications for duodenal ulcer surgery are:

According to our experience indications for gastric ulcer surgery are:
1) Complicated ulcer (perforation, bleeding,
penetration);
2) no effect drug therapy fro three months;
3) Long –term medical history with recurrences of ulcer with unsuccessful drug therapy;
4) Chronic ulcer with epithelial dysplasia IIIst or /and metaplasia
subcardial [juxtacardial, type IV gastric] ulcer.

Johnston` s classification of gastric ulcer (1965):
I type — ulcer of lesser curvature of stomach ( 3 sм under pylorus),
II type — combined ulcer`s of duodenum and stomach,
III type — ulcer`s of pylorus ( up to 3 sм).
IV type - subcardial ( juxtacardial ) ulcer (up to 2 sм from esophagus sphincter)
V type — drug related ulcers