1. Complications of the ulcer disease of the (bleeding, pylorostenosis)
stomach and duodenum
(bleeding, pylorostenosis)

2. Complications of the ulcer disease
perforation
bleeding
penetration
Pylorostenosis
malignization

3. Blood circulation of the stomach

4. Ulcer bleedings Types of bleeding hidden significant arterial venous
capillar

5. «centralization» - at the blood circulation system
At the loss of VCB to 15%
Without acute haemodynamical breaches
Spasm of the vessels:
Pallor of skin
Breach of the microcirculation of the
organs of the abdominal cavity
2. opening of the arteriovenous shunts
State of the vessel
Before the bleeding
State of the vessel after the bleeding
«centralization» - at the blood circulation system

6. At the loss of VCB more than 15%
Reduction of BP
Spasm of the vessels
opening of the arteriovenous shunts
Tachycardia
Liberation of the among cellular liquid and limfa into the circulated blood
Increasing of the concentration of the corticosteroids: aldosteron,
Antidiuretic hormon
Stopping of the liquid in the organism
Increasing of the BP

7. Main breaches at the GDB:
Hypovolemic shock (reduction of the VCB).
Renal insufficiency (hypoxia of the parenchima of kidney and hypofiltration)
Liver insufficiency (breach of the blood circulation in the liver and its hypoxia)
Infarct and hypostasis of brain
Intoxication (suction of the toxins through the intestine)
Functional breachees of the Na и К pomps

8. Breaches, appear after GDB depend on :
    volume of bleeding
    speed of bleeding
     state before bleeding (additional pathology, VCB, gender and other)

9. Organs-dartboards
brain

10. Stages of posthemorragic shock
I – compensation – REVERSIBLE SHOCK
II - subcompensation– HARD REVERSIBLE SHOCK
III - decompensation - NOT REVERSIBLE SHOCK

11. Other reasons of the GIB:
Errosive defeat
of the mucous
of the GIP
Breakup of the
aorta’s aneurism
into the in GIP
angiodysplasy of the
vessels of GIP (syndrome
Of Veber-Osler-Randu)
Blood diseases
Traumas.
Mellory-Vays
syndrome.
Bleeding
from the VEVE
tuberculosis and siphylus
of the stomach
Hypertrophic polyadenomatous
gastritis
(Menetrie syndrome)
Gastrinoma
Polyposis of
the stomach

12. Lately signs of the bleeding
Early signs of the bleeding
dizziness, tachycardia, loss of the consciousness , pallor of the skin, weakness.
Lately signs of the bleeding :
retching «coffee lees» “tar” excrement or melena, reduction or disappearance of pain

13. Classification of the ulcer bleeding by Forrest
1 stage а – pulsing arterial bleeding
1 stage b – active venous bleeding
2 stage а – visible thrombed vessel
2 stage b – fixed thromb or clot
2 stage v – hemorragic imbibition of the fundus of the ulcer
3 stage – ulcer defect without thromb.

14. F-I A – pulsing arterial bleeding; F-I B – venous bleeding;
Active bleeding
F-I A – pulsing arterial bleeding;
F-I B – venous bleeding;

15. F-II B – fixed thromb or clot; F-II A – visible thrombed vessel;
Happened bleeding
F-II B – fixed thromb or clot;
F-II A – visible thrombed vessel;

16. F-II C – hemorragic imbibition of the ulcer’s fundus;
Happened bleeding
F-II C – hemorragic imbibition of the ulcer’s fundus;
F-III pure ulcer’s fundus, absence of the direct visual signs of bleeding

17. Main principles of therapy:
Urgent hospitalization
Bed mode
Cold, hungry
Local and general haemostatic therapy
Reconstruction of the VCB
Antoshock therapy
Plasmo- and haemotransfusions.
Haemostatic therapy:
1% vicasol 3 ml i/m
10% chloride natrium i/v
12,5% aethamzilate natrium (dicinon) i/v or i/m
Σ-amino-capron acid 100 ml 5% i/v, every 4-6 hours
transfusion every 4 hours ml of dry or native plasma

18. Endoscopic haemostasis
Stopping of the continuously bleeding
Prevention of the recidivate bleeding

19. Endoscopic methods of stopping of the bleeding:
Electrocoagulation
Laser haemostasis
Infiltrative haemostasis
injective haemostasis
diathermocoagulation
mechanical method
medicine applications
criostopping
film forming medicines

20. Method of stopping of the bleeding with the help of electrocoagulation

21. Meshanical compression of the source of bleeding;
Injective method (local pricking of the source of bleeding with the medicines, inducting the stopping of bleeding)
Meshanical compression of the source of bleeding;
Vasospaspatic effect;
Increasing of the local development of thromb

22. Methods of the mechanical stopping
1. Clipping
Visible bleeding or not bleeding vessel (in the fundus of the peptic ulcer, at the ulcers of Delafua, VEVE and other).
Bleeding from the bordered surface
(acute ulcer, Mallory-Vais syndrome, place of the tumor’s desinteration, leg of the polyp and other.
2. Ligature
acute ulcer, ulcers of Delafua, polyps.

23. Mechanical method of haemostasis

24. Protection of the ulcer surface
application onto the ulcer defect the polymer medicines, form film: lizol, gastrozol, statizol and biological glue on the base of cyanocrilates (MK-6, МК-7, МК-8).

25. Endovascular haemostasis

26. Gastrotomy and sewinf of the bleeding ulcer
Incision of the ulcer by Djadd
Sewing of the ulcer

27. Differential diagnostic of the GIB
Bleeding from the GIP- retching «coffee lees».
Pulmonary bleeding – bleeding with the scarlet blood, with the foam, separates at coughing.
Estimation of the bleeding by the character of the excrements
The black excrement, formed – bleeding from the upper parts of the GIP, the bleeding is stopped
Black fluid excrement (melena) – bleeding from the upper parts of the GIP, the bleeding is not stopped
Excrement with the scarlet blood – bleeding from the lower parts of the GIP

28. Depending of death on the degree of common state at the GIB
hard degree
Death at the GIB
1 stage
14,28%
2 stage
20,06%
3 stage
64,84%

29. Risk of the recidivate bleeding is more than 90%
Prognosis of the recidivate bleeding
Collaptoid state Presence of the thromb of clot on the fundus of the ulcer at the endoscopic research The sizes of the ulcer are more than 8 mm at the endoscopic research
Risk of the recidivate bleeding is more than 90%

30. Reasons of the pyloroduodenal stenosis
Peryulcer infiltrate
Scaring because of the healing of the ulcer
Hypostasis
Spasm

31. Degrees of the pyloroduodenal stenosis
1 degree – compensation (to 1,5 sm)
2 degree – subcompensation(tp 1- 1,5 sm)
3 degree – decompensation (to 0,5 --smсм)

32. Stage of the compensation
Evacuation through the narrowed intestine the food passes because of the stomach hypersalivation
On the phine of the ulcer clinic the sense of the fullness of the stomach after good feeding
Belch with the bad smell, the sense after the retching reliefed
Normal sizes of the stomach at the X-ray and constipation of the Ba to 3-4 hours, hypermororic.

33. Stage of the subcompensation
The sense of the fullness in the stomach, belch with the smell of bad eggs, pain,
Plural retching,
Remainders of the food in the retching masses
Deterioration of the general status
«Noise of splash» in the epigastria.
at hungry X-ray defines the great volume of liquid in the stomach, reducted peristaltic, stopping of Ba to 6-12 hours, breach of the evacuation through the pyloroduodenal cannel because of narrowing

34. Stage of the decompensation
Breach of the evacuation of the content of the stomach
Significant deterioration of the general status
Stopping of the liquid in the stomach, its dilatation and beginning of the fermentation processes in it.
The sense of the fullness in the stomach, belch with the smell of bad eggs,
Timely relief after inducted retching
Signs of alkalosis, breach of the electrolytes balance, decreasing of the diuresis.
X-ray – stopping of Ba after 24 hours

35. X-ray and endoscopic pictures of the decompensative pylorostenosis

36. Decompensative pylorostenosis
X-ray

37. X-ray of the pylorostenosis

38. Resection of the 2\3 of the stomach
Radical operation
Resection of the 2\3 of the stomach

39. Pyloroplastic by Geyneke-Mikulich

40. Pyloroplastic by Finney

41. GDA by Djabuley

42. Differential diagnostic
Duodenal obstruction at the peryampular tumors
Soldering intestinal obstruction
Cachexy at the oncological diseases
Central anorexy