2. COMLLICATIONS OF CHRONIC PEPTIC ULCERBy
AMGAD FOUAD
Professor Of Surgery
Gastroenterology Center
Mansoura University.

3. Perforation Bleeding Stenosis Malignanacy - Acute - Subacute - Chronic
- Hematemsis Melena Both
Stenosis
- pyloric stenosis - Hourglass Tea-pot
Malignanacy

4. ACUTE PERFORATION Incidence Etiology Ppt alcohol Path
10 – 15 %
DU>GU 10 times
Etiology
Ppt alcohol
Irritant foods
nervousness
Path
Ant >post wall
Stages :
Stage of perforation
stage of reaction
stage of peritonitis

5. C/P Hist : +ve in 80 % Manifestations : 3 stages STAGE OF ONSET
Sudden severe agonising pain
Shock
LUCID INTERVAL:
3 – 6 h
Patient feels & looks better
Tenderness & rigidity remain.
SEPTIC PERITONITIS:
6 hours
Abdomen distended & silent
36 – 48 hours → Toxemia

6. INVESTIGATIONS Clinical Hist → Diagnostic Doubtful Cases
Plain X ray (70 %)
GIT series with water-soluble contrast
TREATMENT
Resuscitation
Urgent surgical intervention (Graham patch).
Definitive surgery

7. Subacute Perforation
A small leaking ulcer allow the body to wall off leaking material from the general cavity by omentum or by the liver with development of Subphrenic abcess

8. Chronic perforation (penetrating ulcer)
The ulcer base penetrates a nearby organ
Liver
Pancreas
Transverse colon

9. BLEEDING PEPTIC ULCER Incidence : Pathology : 65% DU > GU
Hematemsis → GU
Melena → DU
Pathology :
Mild : Granulation tissue
Severe: Vs at floor
Fatal : Penetration of large extragastric artery

10. Investigations: Clinical picture: Long history Massive bleeding
Hypovolemic shock
Hematemsis
Melena
Unless bleeding stops within 48 h → irreversible shock
Investigations:
Fiberoptic endoscopy
Selective celiac angiography.

11. TREATMENT Conservative: Resuscitation Diagnosis Subsequent management
Surgical:
Indication:
Profuse bleeding
age > 45 years.
Associated pathology
procedure :
Aim→ stop bleeding
DU → vagotomy & drainage & under – running
GU → Partial gastrectomy
Endoscopic:
Laser
Sclerotherapy
V.C agents

12. PYLORIC STENOSIS (GASTRIC OUTLET OBSTRUCTION)
Pathology:
Duod bulb → Cicatrized & stenosed
Stomach → Hypertrophied → Dilated
Intestine →Normal & Collapsed
Complications:
Metabolic Alkalosis
Fluid & electrolyte imbalance
Dehydration
Antral Stasis
Respiratory complications

13. CLINICAL PICTURE Long history: Symptoms: Distention Pain Vomiting
Lost periodicity
Progressive constipation
Picture of complications
Signs:
General → Dehydration
→ Tetany
→ Mental confusion
Abdominal → Epigastric fullness
→ Visible peristaltic waves
→ Succussion splash
→ Food residue

14. INVESTIGATIONS Blood chemistry Gastric function tests
Ba Meal (soup dish appearance)
Endoscopy.

15. TREATMENT Pre-operative preparation: Surgery: Gastric lavage IV fluid
Abx
Surgery:
The only method of cure
Vagotomy & drainage
Gastrectomy

16. Thank you