1. GASTER, DUODENUM, AND PANCREAS
Dr. Sigid djuniawan,spB

2. PEPTIC ULCER & DUODENAL ULCER
Corrosive action in oesophagus, duodenum, stomach, jejunum, ileum
2% adult in USA
Men :women = 3 :1
Sign and symptom : pain, bleeding, perforation, obstruction (pylorus, gastroesophageal junction)
Therapy ; somatostatin,antasida, H2 antagonis, antibiotic, surgical (ligation, vagotomi+piloroplasti, gastrektomi; indication : malinancy –prepyloric in major curve, indolence in posterior)
Complication : perforation (10%)
DUODENAL ULCER
Epigastric pain relieved by food or antacid
Epigastric tenderness
Normal or increased gastric acid secretion
Sign of ulcer disease on upper git
Evidence of H pylori infection
Young and midle age (20-45) , men> women
95% within 2 cm pylorus in the duodenal bulb
Complication : hemorrhage, perforation, duodenal obstruction
Surgical : vagotomy truncal, antrectomy plus vagotomy, subtotal gastectomy

7. Complication of surgery
Early : leakage, gastric retention, hemorrhage
Late : reccurent ulcer, fistula gastrojejunocolic and gastrocolic
Dumping syndome (after eating : palpitations, sweating, dyspnea, flushing, nausea, abdominal cramps, vomiting, diare, syncope)
Alkaline gastritis
Anemia
Chronic gastropharesis
Zollinger-Ellison syndrome
Gastric acis hypersecretion by gastrinoma (pancreas, duodenum, antrum)
Treatment : H2 blocking agent, resection

10. Gastric carcinoma 20.000 new cases in USA H pylori infection
Male > female, yo, low economy, blood A
Predisposition : Low disetary vegetables and fruits, high intake starches, salt, chronic ulcus in gaster,salting fish
Mean age 60 yo, rare < 40 yo
Adenocarcinoma (HPA : intestinal type, diffus type)
40% in antrum, lesser curve, 30% fundus, 25% cardia
Clinical : abdominal discomfort after meal, anorexia, weight loss, anemia
Lab : anemia, CEA >, usg endoscopy, CT, Sitology gaster fluid
Metastatic : early and spreading (limfogen : st Mary Yoseph’s node, Virchow’s node, Troisier sign) , hematogen,ovarial (krukenberg’s tumour), adjascent structure (rare)
Imaging ; gastroscopy and biopsy
Early : mucous and submucous, Japanese endoscopy (proliferant, superficial, ulcerating)
Advance : (Borrmann) fungating, excavated, ulcerated-infiltratif, scirrhous –linitis plastica/ diffused thickened
Morfolgy : fungating, malignant ulcus, infltrating
Treatment : curative treatment (surgical resection), 85% operable, reconstruction by bilroth I dan II, total gastrectomy and splenectomy, Paliatif : gastrostomy, enterostomy

13. Complication after surgery :
early : acute dilatation, stoma obstruction, leakage
late ; dumping syndrome, diarhea, gastritis, obstruction, marginal peptic ulcer

14. Duodenum Duodenal diverticula Duodenal tumors
Adenocarcinoma, leiomyosarcomas, lymphomas
Descending duodenum
Pain, obstruction, bleeding, obstructive jaundice, abdominal mass
Endoscopy and biopsy
therapy : resected, pancreaticoduodenectomy
Unresectable  radiotherapy