1. LECTURE 7 Surgery in peptic ulcer disease National O. Bogomolets Medical University Faculty Surgery Department N1 Kyiv 2008 Prof. Kucher M.

4. duodenum ulcer pathogenesis: An ulcer is now known to be the result of an imbalance between aggressive and defensive mechanisms in the stomach and duodenum. Part of that imbalance can be attributed to infection by H. pylori . Altetarion Protection balance

6. duodenum ulcer pathogenesis: H.Pylori Inflammatory response -> gastritis Stimulate Gastrin production

7. duodenum ulcer pathogenesis: Subsequent Hypersecretion of H + H.Pylori Inflammatory response -> gastritis Stimulate Gastrin production Gastric metaplasia of duodenal mucosa

8. duodenum ulcer pathogenesis: Altetarion Subsequent Hypersecretion of H + Colonization of metaplastic areas H.Pylori Inflammatory response -> gastritis Stimulate Gastrin production Gastric metaplasia of duodenal mucosa

9. duodenum ulcer pathogenesis: Altetarion Protection MUCUS: glycoproteins, water, electrolytes (HCO) Subsequent Hypersecretion of H + Colonization of metaplastic areas H.Pylori Inflammatory response -> gastritis Stimulate Gastrin production Gastric metaplasia of duodenal mucosa

10. duodenum ulcer pathogenesis: Protection MUCUS: glycoproteins, water, electrolytes (HCO) NSAIDs PROSTAGLANDIN E2

21. Truncal Vagotomy + Heineke-Mikulicz pyloroplasty

22. Highly Selective Vagotomy (Parietal Cell Vagotomy)

25. B1 and BII gastrectomy

27. Operations for high-lying ulcers near the gastroesophageal junction (type IV)

28. COMPLICATIONS OF PEPTIC ULCERATION REQUIRING OPERATIVE INTERVENTION

45. ACUTE HAEMORRHAGE FORREST – endoscopic classification of upper gastrointestinal hemorrhage Acute hemorrhage Forrest I a Arterial, spurting hemorrhage Forrest I b Oozing hemorrhage Signs of recent hemorrhage Forrest II a g = vessel < 2mm Visible vessel G = vessel > 2mm Forrest II b Adherent clot Forrest II c Hematin- covered lesion Lesions without active bleeding Forrest III No signs of recent hemorrhage Forrest J.A.,Finlayson N.D. “Endoscopy in gastrointestinal bleeding.” Lancet, 1974, N11, p.394-399

46. endoscopic treatment: vessel clipping