: :26 / GERD -"

:
:
-Angle of His .
-Incisura angularis , .
-Rt. Lt. gastric, Rt. Lt. gastroepiploic, Inf. Phrenic, short gastric :
. . hepatic A 20%- -
L. gastric .
:
-R, L gastric V
-Lt. gastroepiploic V
-Rt. GastroepiploicSMV-
:
- ) 90% 10%-( . , ,carotid sheath-
)( , , .
. hepatic branch celiac branchceliac-
.plexus .ant. Latarge - =
crow foot post. Latarge.
- trunk trunkal vagotomy- ant. Latarge- selective
) vagotomy = hepatic branch), parietal cell vagotomy, proximal gastric vagotomy
- highly selective vagotomy .crow foot- ,.
-Criminal nerve of grassi post. Vagus-
. truncal vagotomy- .
.T5-10 celiac plexus

:
.1
.2
.3
.4

- : , ,
- - , , , , )
(
-

:
.1 -.IF ,
.2
-Chif .3
-ECL .4
-D .5 - , G - ECL- .
-G .6
, .
, , D, ECL G-
G ECL.
-30% - .
-70% - )( , ) ( ,
-10% - ''
:
, .
) ( . .

 -Erosion ,
- -.
H. pylori + ) NSAID , ,(.
- , . , .
- .
) (:
-type I ,incisura angularis- , , .antral gastritis
-Type II + I
-Type III , 2" ,-
-Type IV.
II, III ) ( .
H. pylori
,1982- 1987- . . 90%-
75%- Rod . , ) ( .
) CO2-( . ? ,
. D .
, , . ) (
) MALToma- ( . ) (PPI, H2
.75%- .25%-
.2%-
:
.1 : , ) , 3-5 , ,(H&E
) rapid urease test , - -pH
.(pH
14
13
.2 : ) C ,C CO2
( , ) ,
- ( . 4 .
-NSAID ) HP (
10% ) NSAID ( . .
.
:
: )( , , . ,
) (.
)(.
: , ) ,(5% ) , ,(.
.
, .
- . .gastric outlet obstraction - K-
) HCl K Cl-(.
:

40%- - .II III .
- .
) (.
:

 , ,.
-NSAID COX2
) PG (.
) (antacids - )( ) ,(.
85%.
-H2 , - 80% 90% , .
-PPI .
, .
85% . 96%- .
) 4-5( . ) -H2
(.
-HP- ) PPI : ( +' + )(
.
-Intractable duodenal ulcer 12 .
:
) vagotomy 10-15% -(trunkal- .
" -Heineke-Mikulicz pyloroplasty - .
) finne : (-jabuler (gastro-duadenoplasty ,
( . truncal- selective vagotomy- highly-
selective vagotomy ) crow foot- .(5-25%
) Antrectomy ( -vagotomy + ) .(0-2% ,
. ) billroth I gastro- -
(duadenostomy ) billroth II
(jejunum .
-
80%
/
- - ) , ( ) ,-
, , - (.
- ) ( , ,60
, ) , - ,50%
( . .
- ) 30% 10%( . :
- ) ( GDA .
truncal vagotomy )
( 90%- HP . HP
, .
-type I - ) I .(IV-
NSAID -truncal vagotomy. Type II/III
.truncal vagotomy-
- HP
?truncal vagotomy HP- , .
- ) -omentum)- patch
." .HP-
- ) ( .
, , .
: ) (.