Principles of Management of Complicated Peptic Ulcer Disease

Vocabulary flashcards about Peptic Ulcer Disease

Hematemesis

Vomiting of blood

Melena

Passage of dark black, tarry stools

Correction of hypovolemia

Restoration of blood volume using intravenous fluids and blood products

IV H2 receptor blockers or omeprazole

Medications that reduce stomach acid production

Lavage of the stomach

Washing out the stomach with cold saline solution

Indication of endoscopic hemostasis 1

The ulcer is actively bleeding

Stigmata of recent bleeding

Likelihood for rebleeding

Forrest Ia

Arterial spurting

Forrest Ib

Oozing from the ulcer base

Forrest IIa

Visible vessel

Forrest IIb

Adherent clot

Forrest IIc

Black spots

Forrest III

Clean ulcer base

Pyloroduodenotomy

A procedure involving incision into the pylorus and suturing to widen the opening

Left Gastric Artery

Supplies the cardia of the stomach and distal esophagus.

Splenic Artery

Gives rise to 2 branches which help supply the greater curvature of the stomach; Left Gastroepiploic, Short Gastric Arteries

Common Hepatic

Two major branches RightGastric- supplies a portion of the lesser curvature Gastroduodenal artery-Gives riseto Right Gastroepiploic artery Helpssupply greater curvature in conjunction with Left Gastroepiploic Artery

Vagotomy

Cutting the vagus nerve to eliminate acid-secretion stimulus

PYLOROPLASTY

Used to widen the pylorus to guarantee stomach emptying even without vagus nerve stimulation

ANTRECTOMY/ SUBTOTAL GASTRECTOMY

Lower half of stomach (antrum) makes most of the acid – Removing this portion (antrectomy) decreases acid production

Billroth I

Distal portion of the stomach is removed and the remainder is anastomosed to the duodenum

Billroth II

The lower portion of the stomach is removed and the remainder is anastomosed to the jejunum

Stage of perforation

Gastric contents enter the peritoneal cavity.

Stage of chemical peritonitis

The peritoneum reacts by producing serous alkaline fluid, neutralizing the acid and bringing antibodies to hinder bacteria growth temporarily.

Stage of septic peritonitis

Microorganisms invade the peritoneal cavity and pus forms.

At operation of perforated peptic ulcer

Closure of the perforation with a covering omental patch.

Pylorus

Cicatrized and stenosed, showing the specific pathology.

Stomach

At first hypertrophied then dilated may reach down to the pelvis.

Pyloric stenosis

requires surgery; it is not an emergency and needs Proper Preoperative Preparation

Peptic Ulcer Definition

A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection.

Peptic Ulcer

Most common cause of upper GI bleeding

Duodenal Ulcers

duodenal sites are 4x as common as gastric sites

Hematemesis

Dark coffee ground due to acid hematin

Melena

Altered blood in stools