Gastric and duodenal

ulcer disease
 Ulcer disease
 ulcer is a defect of gastric or duodenal mucosa which
interfere over lamina muscularis mucosae, submucosa or
penetrates across whole gastric or duodenal wall

 rise of ulcer is conditioned by presence of acid gastric

content

 frequent disease, men are afected 3-4x more than women

 Pathogenesis:

 multifactorial

 dysbalance between protective and aggressive factors

- Protective f.: saliva, food, alcalic duodenal fluid, mucus -

mucine, fast regeneration of gastric epithelial cells, well
perfused gastric mucosa

- Aggressive f.: HCl, pepsin, bile acids (reflux), helicobacter

pylori, drugs (analgetics, aspirin, korticoids), nicotine,
alcohol
 Classification:

Acute ulcer (ulcus acutum)

 smooth non-elevated borders and smooth base
 major bleeding into upper GIT

Chronic ulcer (ulcus chronicum)

 rushed and elevated boders, inflammation with
hypertrophic and fibrotic proliferation is present
 the most frequent form of ulcer disease

• Ulcus chronicum mediogastricum

• Ulcus chronicum ventriculi et duodeni
• Ulcus chronicum praepyloricum
• Ulcus chronicum duodeni
 Symptoms of gastric ulcer disease:

 epigastric pain after meal or during meal

 upper dyspeptic syndrome – loss of appetite, nauzea,

vomiting, flatulence

 vomiting brings relief

 reduced nutrition

 loss of weight
 Symptoms of duodenal ulcer disease:

 epigastric pain 2 hours after meal or on a empty

stomach or during night

 pyrosis

 good nutrition

 obstipation

 seasonal dependence (spring, autumn)

 Complications:

 Bleeding - chronic (minor, cause anaemia)

- acute (major, form affected vessel)

 Perforation - mostly bulbus duodeni, anterior gastric wall

- acute violent pain
- bleeding can be present

 Penetration - of the ulcer deeply through whole wall into

neighbor organ (pancreas, liver)

 Stenosis - narrow of the lumen caused by scar, oedema or

inflammatory infiltration after healing of the ulcer
- rise only at pyloric localization
- vomiting of huge volume of gastric content
 Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004

A – penetration B – perforation
C – bleeding D - stenosis
 Therapy:

 Conservative
• regular lifestyle
• prohibition of the smoking and alcohol
• diet (proteins, milk and milky products)
• pharmacology (antagonists of H2 receptors,
antacids, anticholinergics

 Surgical
• BI, BII resection
• proximal selective vagotomy
• vagotomy with pyloroplastic
• suture of perforated or haemorrhagic ulcer
 Stomach resections:

 Billroth I (BI) – gastro-duodenoanastomosis end-to-end

 Billroth II (BII) – gastro-jejunoanastomosis end-to-side

with blind closure of duodenum

 Proximal selective vagotomy – denervation of parietal

gastric cells
 Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004

Billroth I
 Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004

Billroth II
 Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004

Gastro-enteroanastomosis on
Roux Y crankle
 Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004

Vagotomy
 Complications after stomach resection:

 Early – dehiscence, stenosis of anastomosis, bleeding,

pancreatitis, obstructive icterus, affection of neighbour
tissues

 Late - days, weeks

- early dumping syndrome
- late dumping syndrome
- incoming crankle syndrome
- outcoming crankle syndrome
- ulcer in anastomosis or in outcoming crankle
 Early dumping syndrome:

 group of symptoms approved shortly after meal

 appears after BII resection

 vasomotoric sy. - face redness, fall of blood pressure,

dizziness

 GI sy. - vomiting, diarrhoea

 Th.: diet, no sugar, low quantities of food, change BII to

BI resection
 Late dumping syndrome:

 hypoglycaemia (sugar is not enough digested)

 appears after BII resection

 weakness, perspiration, dizziness, tremor cca 3h after

meal

 Th.: no sugar, change BII to BI resection

 Incoming crankle syndrome:

 stasis of the content at incoming crankle increase

intraluminal pressure

 appears after BII resection

 Th.: diet, change BII to BI resection

 Outcoming crankle syndrome:

 chronic or acute closure of outcoming crankle

 appears after BII resection

 vomiting after meal, convulsive pain

 Th.: change BII to BI resection

Haemorrhagic mediogastric
ulcer
Chronic gastric ulcer
Pylorostenosis and gastrectasia
Duodenal ulcer
Stress ulcers
 Benign stomach tumors
 rise from all layers of stomach wall

 often asymptomatic

 Polypus, Leiomyoma, Lipoma, Fibroma, Neurofibroma,

Neurinoma, Hemangioma, Karcinoids, Lymfoma

 Diagnostic: endoscopy, X – ray

 Therapy: local excision, stomach resection

 Stomach cancer
 Symptoms:
 long-time asymptomatic
 feeling of full stomach, odour from mouth, tiredness,
anaemia, occasional vomiting, loss of appetite, loss of
weight

 Diagnosis:
 gastrofibroscopy – biopsy - histology
 X-ray, USG, CT - metastasis
 Wirchow´s nodule – enlargement of left supraclavicular
nodule
 Stomach cancer
 Etiopathogenesis:
 Praecancerosis: adenomatous polypus, chronic atrofic
gastritis, foveolar hyperplasia (Ménétrier disease), stub
of the stomach after BII resection

 Division:
 Macroscopic: exofytic polypoid form, diskyform
ulcerous form, diffused infiltrating form

 Histopathologic: adenocarcinoma, papilar, tubular,

gelatinous cancer, round cell cancer, flagstone cell
cancer, etc.
 Stomach cancer

Zeman, M. et al., Speciální chirurgie, ISBN 80-7262-260-9, 2004

 Therapy:

 Currative – total gastrectomy, sub-total gastrectomy

 Paliative – gastrostomy, jejunostomy
Gastric cancer
Gastric stub cancer after B II
resection
Schwanoma fundi vetriculi
Than you for your attention!!!