外科-消化性溃疡PPT.ppt

X-ray Gastroscopy Biopsy to rule out malignancy Even 1) results considered though 2) ulcer is judged to be benign 4% will prove to be malignant GU Bleeding Obstuction Perforation Malignant change Complications GU Treatment dominated by op. Reasons for treatment dominated by op. 1) difficult to cure medically 2) recur frequently cause more severe symptoms than DU Recurrence rate: first 2 years 40% first year 70% 3) If the ulcer fails to heal, difficult to differentiate from cancer. 4) Gastrectomy cures GU efficiently GU Surgical Treatment for GU 1) 40~50% partial gastrectomy Billroth I reconstruction 90% satisfactory Mortality 10% GU 2) Vagotomy plus pyloroplasty in a critically ill bleeding ulcer in elderly pts. GU 3) Treatment as outlined in the section on DU 1. The gastric ulcers near the pylorus 2. The ulcers also associated with hypersecrection 3. X-ray changes similar to DU GU Complications of Peptic Ulcer Complications of Peptic Ulcer 1. Perforated ulcer 2. Obstruction 3. Bleeding(Heamarrhage) 4. Malignant change 0% DU 1% GU Long history Not malignant ? Perforated Peptic Ulcer Occurrence common abdominal emergency acute appendicitis perforated ulcer intestinal obstruction acute biliary infection Perforation: 10% of all peptic ulcers 90% in DU 90% in males esp. 25~50 y common sites: anterior DU GU on the lesser curverture gastric Ca occasionally Pathophysiology of Perforated Peptic Ulcer perforation chemical peritonitis culture(-) over 6~8 hr bacterial peritonitis Severe