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 layer Serous layer Mucous layer Submucous layer Muscle layer Mucous layer Serous layer

Endoscopic picture of the acute and chronic ulcer Acute ulcerChronic 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 minutes after food intake Late: pain occurs only 2 hours after food intake Season independentSeason 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 times mov effective. The antisecretory inluence duration is — 8-10 hours in ranitidine, 12 – hours in famotidine

Eradication treatment variants TypesDrugsEffectivity First stage of the eradication treatment 3 component treatment 1.IPP 2.Amoxillin 3.Craritromycin 70-86% 1.1. Claritromycin resistancy, 1.IPP 2.Amoxillin 3.Metronidazole 1.2. Allergy to penicillin 1.IPP 2.Claritromycin 3.Metronidazole Second stage of the eradication treatment Four component treatment 1.IPP 2.Bismute tripotassiumdicitrate 3.Metronidazole 4.Tetracyclin 76-90%

Gayneke-Mikulich pyloroplastic approach Finney pyloroplastic approach

Gastroduodenostomy by Jabuley’s method

Bilroth 1 and Bilroth 2

Bilrot -I Bilrot -II