13 - 14 Stomach

Stomach - Dr.
Al-Matary
pathology
clinical pictures
investigations
treatment
pathology
Pyloric hypertrophy
pyloric obstruction Hypertrophy
pyloric stenosis
pyloric stenosis pyloric obstruction
acute condition Pyloric obstruction
pyloric obstruction
pyloric stenosis
dehydrated
stenosis
Obstruction stenosis
Page | 1
Stomach - Dr. Al-Matary
acute condition obstruction

chronic condition stenosis
pyloric hypertrophy
Pyloric hypertrophy
hypertrophy
Hypertrophy
pyloric sphincter pyloric sphincter
hypertrophy thick pyloric sphincter

duodenum pylorus
Fades gradually towards the stomach and Stop abruptly at the duodenum
duodenum
stenosis pylorus Pathology
Obstruction
Pyloric sphincter hypertrophy

duodenum pylorus
Hypertrophy
Fades gradually toward the stomach but stop abruptly at the duodenum
congenital hypertrophic pyloric stenosis

complications
under weight
simple reflux
pathology physiology
Physiology
pylorus hypertrophy
under weight pathology
Page | 2
bad chest Under weight

bad chest under weight
electrolyte imbalance
HCL
HCL
dehydrated
dehydrated H2O
hypo nateremia dehydration

complications
HCL
dehydrated HCL
Kidney
kidney
Salt and water retention
positive ions kidney

positive ions Positive ions
kidney
Page | 3
Kidney
hypo kalemia Hypo natremia dehydrated
Kidney
alkalosis
HCL
HCL
alkalosis
Urine
acidic urine acidic
alkaline Urine alkaline
kidney PH
paradox
acidic urine alkaline
paradoxical aciduria
urine acidity alkalosis
pathology
pylorus stenosis
hypertrophy
fades gradually towards the stomach Hypertrophy

end abruptly at the duodenum
complications
pylorus stenosis
Page | 4
Under weight
dehydrated bad chest
dehydration
dehydration
renal compensation
kidney
paradoxical aciduria

alkalosis
ionized calcium
alkalosis
alkalosis
Saline
saline rehydration
saline rehydration
MCQ
saline rehydration start
saline
CHPS
Page | 5
CHPS
Male
male
esophageal atresia
projectile vomiting
intestinal obstruction Projectile vomiting
projectile
volvulous neonatorum
Volvulous neonatorum
acute condition volvulous neonatorum

severe abdominal distention
Upper abdomen dyspepsia
Upper abdomen dyspepsia
severe colic severe abdominal distention volvulous neonatorum

chronic condition CHPS
colic
projectile
bile stained vomiting volvulous neonatorum

bile hypertrophy Pylorus bile vomiting CHPS
Page | 6
Not bile stained

treatment
MCQ saline
Not bile stained

Intestinal obstruction CHPS
not bile stained Intestinal obstruction CHPS
upper abdominal distention

vomiting upper abdominal distention
Not bile stained vomiting
general
Absolute
chronic condition
general examination
dehydrated Bad chest
under weight
CHPS
3.5
3.5
He doesn’t get weight
He doesn’t get weight
simple reflex
simple reflex
weight
Page | 7
general examination
Under weight
bad chest dehydrated
local examination
peristalsis
Hypertrophy
peristalsis
muscle contractility Starling law distention distention

peristalsis
wave of anti peristalsis
wave of peristalsis
CHPS
Local examination

Peristalsis 
wave of anti peristalsis wave of peristalsis peristalsis
peristalsis local examination
CHPS
saline
treatment
saline
saline dehydrated
saline dehydrated
Page | 8
saline rehydration

Ramstedt’s pyloromyotomy pylorus
pylorus
Ramstedt’s pyloromyotomy pylorus
Ramstedt’s pyloromyotomy
circular muscle fiber
pyloroplasty
pyloromyotomy
healing by fibrosis
healing by fibrosis
Gridiron incision
pylorus
vein of
vein of
pyloric sphincter
Gridiron incision
Internal oblique external oblique
Page | 9
transverse abdomins
umbilicus
Gridiron
Gridiron
Umbilicus Gridiron
pylorus

body fundus
Pylorus
umbilicus
mucosa
mucosa
Muscles
serosa
serosa Muscle
serosa
muscles serosa
patent mucosa
Mucosa
Mucosa
Repair with interrupted sutures and reinforced by omental patch

Ramstedt’s pyloromyotomy
Page | 10
rehydration
limited Medical treatment role

very mild cases Limited
dehydrated bad chest bad general condition
Medical
Pneumonia
medical Pneumonia
free chest
Medical treatment Indication

Very limited
medical treatment Indication written

bad general condition Mild cases
acute peptic ulcer
Investigations
CHPS
X-ray gastrographin barium
ultra sound saline
ultra sound gastrographin
X-ray gastrographin
Page | 11
gastrographin saline sonar

saline
fluid
D
Dilated 
Delayed emptying 
delayed empty dilated
String sign
pylorus
String sign
DDS Gastrographin
Dilated 
Delayed emptying 
String sign 
String sign extremely an important
delayed emptying dilated stomach barium

diagnosis
delayed emptying dilated stomach
acute peptic ulcer

Acute peptic ulcer
Peptic ulcer
Loss of continuity of epithelium
ulcer
Peptic
stomach Peptic
pepsin pepsinogen
Page | 12
pepsin pepsinogen Stomach Peptic
discontinuity of epithelium
Due to gastric juice
stomach ulcer
reflux
esophagus HCL
Longitudinal muscle fibers circular muscle fibers epithelium
epithelium
  
circular muscle fiber
longitudinal muscle fibers
epithelium HCL
peptic ulcer esophagus
reflux
due to gastric juice Ulcer

peptic ulcer
gastric juice Ulcer
duodenum gastric juice HCL

Peptic ulcer
peptic juice duodenum gastric juice
Page | 13
Zollinger Ellison syndrome

jejunum duodenum acidity
peptic ulcer
Peptic ulcer jejunum
Mickle’s diverticulum
ectopic gastric tissue Mickle’s diverticulum
HCL ectopic gastric tissue
Mickle’s diverticulum peptic ulcer
Peptic ulcer
Ulcer
related to gastric juice Ulcer
definition
Ulcer Ulcer
Due to gastric juice
peptic ulcer
Malignant ulcer inflammatory ulcer ulcer
Irritant
chemical
Ulcer Chemical irritant

inflammatory ulcer
Inflammatory ulcer Chemical irritant

chemical irritant
Inflammatory ulcer
Ulcer
Acute 
Chronic 
Chemical irritant Peptic ulcer
Page | 14
chronic acute
acute Ulcer
mucosa
edematous congested
acute
fibrosis Healing granulation tissue chronicity

end arteritis obliterans blood vessel
fibrotic edges
chronicity
chronic acute ulcer

Inadequate treatment, bad general condition, predisposing factors
Inflammation
chronic acute ulcer

Inadequate treatment
chronic osteo myelitis acute osteo myelitis
Inadequate treatment

acute peptic ulcer

Mucous membrane HCL
mucous membrane HCL
ulcer
Page | 15
Ulcer
acidity Mucous membrane
stress
reflux stress
stress
stress
poly traumatized patient
rupture humerus rupture clavicle

rupture spleen rupture pelvis
 under stress
Stress
stress
stress
stress stress
stress
severe stress
stress Poly traumatized patient Burn

stress
Mucous membrane
Page | 16
Mucous membrane
Mucous membrane
mucous membrane
stress ulcer

Mucous membrane 
Cushing ulcer stress ulcer

stress Ulcer
Cushing ulcer
Cushing
Cushing
Cushing syndrome
Cushing disease
Cushing syndrome Cushing disease
pituitary Cushing disease
adrenal Cushing syndrome
Cushing
cortisone Stress
ulcer
Cushing ulcer
duodenum Metabolite
second part of the duodenum
Curling’s ulcer
Curling’s ulcer
Page | 17
Cushing ulcer 
Curling’s ulcer 
multiple ulcers
acute
multiple small minute ulcers
Multiple small minute ulcers
multiple small minute ulcers
acute gastric erosion
acute peptic ulcer

acute peptic ulcer
Page | 18
30
30
mucous membrane
Mucous membrane
 resuscitate vital
temperature blood pressure pulse
Page | 19
shocked
rebound tenderness rigidity guarding
guarding tenderness
shifting dullness rebound tenderness rigidity guarding
diagnosis Investigation
endoscope
Barium
bleeding
Barium + Bleeding equal
endoscope
therapeutic diagnostic endoscope
adrenaline Ulcer
Page | 20
therapeutic diagnostic
Angio
angio
ischemia angio
Pre operative preparation
talent
Bleeding
Angio
multiple ulcers
resuscitation
resuscitation vital
abdomen Pain
Page | 21
general examination
tenderness guarding
local examination
local examination general examination symptoms
acute peptic ulcer

resuscitation
fluid catheter Line ryle
resuscitation
fluid catheter line ryle
Mucous membrane
Omeperazole intravenous acidity
Rantidine Cimetidine
Omeprazole
Mucous membrane acidity
cold antacids cold saline ryle wash
vaso constriction
congestion gastritis
gastritis congestion
Page | 22
cold antacids cold saline
cold saline Omeprazole
vein artery
veins
Vasopressin
Vasopressin + Glycine glypressin
somatostatin
esophageal varices
GIT
Vasopressin
Vasopressin
Vasopressin
Vasopressin
Vasopressin
vasoconstriction
vasoconstriction vasoconstriction
vasoconstriction
vein vasoconstriction artery

constriction vein
preload after load vasoconstriction

cardiology
Page | 23
catecholamine vasoconstriction
pre load after load
vasoconstriction arteriole
vein
smooth muscle vein

Portal
Portal vein smooth muscle
portal
GIT Portal
splanchnic GIT
splanchnic venous pressure vasopressin
smooth muscle vein

Portal vein
systemic arteries systemic veins

vein
Portal
GIT bleeding vasopressin
vasopressin
laser
laser
Page | 24
shocked
omeprazole cold saline resuscitation

Vasopressin


Intestine fundus
bleeding
Generous gastrectomy

generous gastrectomy

generous gastrectomy

follow up
shocked
catheter Line ryle fluid
400 ryle 500 ryle
Page | 25
follow up
500 ryle
500
500
clotting factors platelets
clotting factors
platelets
DIC
500 500
source
source
300 400 500

follow up
follow up
osteomyelitis
within 48 hours antibiotic
anti thyroid drugs

8
Page | 26
follow up
acute peptic ulcer

written acute peptic ulcer
chronic peptic ulcer

Chronic peptic ulcer
treatment investigation clinical pictures Pathology
treatment written

Enjoy your time 

chronic peptic ulcer Pathology
peptic ulcer pathology
Infection peptic ulcer 

Helicobacter Pylori infection
lesser curve Peptic ulcer
lesser curve
lesser curve lesser curve lesser curve

lesser curve
Page | 27
small minute embolous Peptic ulcer

small minute vessel
small minute ulcer
HCL
ischemic
small minute
small minute embolous

small minute vessel
ischemia
Small minute part
HCL
hypo vitaminosis
regeneration of the epithelium vitamin C vitamin A
peptic ulcer
Liver diseases
gastrin Liver
gastrin
hepato-splenomegaly
esophageal varices 
peptic ulcer 
Hepato-splenomegaly
varices Hepato-splenomegaly
Page | 28
hepato-splenomegaly
Peptic ulcer varices
Liver disease
peptic ulcer
gastrin Liver
 spicy food Peptic ulcer
Mucous membrane
HCL
Helicobacter pylori
Helicobacter pylori

Helicobacter pylori
examiner
Helicobacter peptic ulcer Helicobacter pylori
Helicobacter pylori More details
Helicobacter

Helicobacter
Page | 29
80 %
60 % 50 
80 %
60 % 50 
peptic ulcer
Helicobacter pylori
Infected dose
Infected dose
Helicobacter
Helicobacter
Mucous membrane
mucous membrane
vasodilatation
Muocus membrane edema
mucous membrane HCL
Ulcer
ulcer
Mucous membrane HCL
Page | 30
ureate positive
alkaline acidic
Alkaline
alkaline
alkaline
alkaline
stimulate HCL secretion alkaline
HCL
Mucous membrane
Helicobacter pylori
peptic ulcer
stimulate
stimulate amonia formation
stimulate amonia formation
Helicobacter Peptic ulcer
antibody titer
Helicobacter
antibody titer
Page | 31
Helicobacter

Helicobacter pylori
peptic ulcer Helicobacter

stimulate amonia formation stimulation
 Stimulate
Stimulate
amonia formation Sitmulate

duodenum stomach
Stomach chronic peptic ulcer
Peri-pylorus lesser curve

gastric ulcer
peri-pylorus lesser curve
lesser curve
mechanical theory
Lesser curve
Mucous membrane
 Lesser curve
Lesser curve 
Page | 32
lesser curve
Liable for tear and wear lesser curve
peri-pylorus
HCL
parietal cells
G cells
gastrin G cells
gastrin G cells
pylorus
Parietal cells HCL

body
HCL Parietal cells

HCL mucous membrane
function complex
parietal cells
HCL
back diffusion HCL
histology
Functional complex
HCL body
HCL
HCL
Page | 33
pylorus
body abnormal ulcer

malignancy
Pathology
Malignancy HCL
body HCL
rare
Ulcer niche in abnormal site
suspect cancer stomach

other than the ulcer bearing area ulcer niche
ulcer bearing area

ulcer
Ulcer bearing area

peri-pyloric lesser curve
Ulcer
ulcer
duodenal ulcer
first inch of first part of the duodenum
acids
anterior wall of the duodenum Ulcer

Posterior wall anterior wall
Kissing ulcer
Page | 34
anterior wall of the duodenum ulcer 

posterior wall of the duodenum anterior wall of the duodenum Ulcer 
Kissing ulcer
Posterior anterior ulcer

anterior
Posterior ulcer
Posterior ulcer
gastro-duodenal artery
anterior ulcer
Gastro-duodenal artery posterior ulcer posterior ulcer
duodenal ulcer
Stress
stress
stress
peptic ulcer stress
Page | 35
stress
stress
Peptic ulcer female Peptic ulcer
females males
under stress
more common in males gastric ulcer
stress
auto immune atrophic gastritis

More common in females
Mucous Atrophy
atrophic gastritis
atuo immune
More common in females Auto immune
Mucous membrane atrophy
females
Page | 36
duodenal ulcer gastric ulcer

males
Males duodenal ulcer
males gastric ulcer

atrophic gastritis
hyper acidity duodenal ulcer
Hyper acidity gastric ulcer

hypo acidity atrophic gastritis
duodenal ulcer
hyper acidity
gastric ulcer
hyper acidity

stomach
mucous membrane
Mucous membrane acid
Simian crease
stomach Mucous membrane
Page | 37
gastric ulcer
duodenal ulcer acidity
peptic ulcer
atrophic gastritis acidity
mucous membrane acid

acidity
Mucous membrane
acidity Mucous membrane balance

acidity acidity
acidity Mucous membrane balance
gastric ulcer
gastric ulcer
general condition of the patient
Omeprazole
acidity
aggressive Omeprazole atrophic gastritis gastric ulcer

Rantidine
acidity
Mucous membrane acidity
Mucous membrane Acidity
duodenal ulcer coating agents sucralfate
ulcer
acid
acids
acids Sucralfate
Page | 38
HCL
peptic ulcer
mechanism What ever

mucous membrane acidity balance
females More common in males duodenal ulcer

males
gastric ulcer
Males
duodenal ulcer
ulcer bearing area
first inch of first part of the duodenum
ulcer bearing area gastric ulcer

prepylorus lesser curve
Ulcer gastric ulcer duodenal ulcer

non specific ulcer
acute phase serrated edge sloping edge
Later on
punched out
serrated edge sloping edge

Later on
puched out
end arteritis obliterans Punched out
venous ulcer
serrated edge slopping edge
chronic
Punched out
Page | 39
End arteritis obliterans

Perpendicular blood supply

Ulcer
serrated edge slopping edge
after traumatic
chronic
punched out
End arteritis obliterans
duodenal ulcer
non specific ulcer
slopping serrated edge acute
end arteritis obliterans chronic

Punched out edge Ulcer
Perpendicular blood supply
stomach ulcer
mucosa
mucosa
mucosa
musclosa
Musclosa
serosa
inflammatory process Ulcer

granulation tissue
healing
fibrosis
Page | 40
fibrotic Ulcer
fibrosis granulation tissue

serosa
fibrosis
Mucosa Ulcer
fibrosis granulation tissue
serosa
ulcer
serosa
fragile capillaries
petichae
petichae Ulcer
petichae Ulcer
Ulcer
Fibrosis
Ulcer
Loss of luster of serosa 
Indurated Ulcer 
Petichae 
Ulcer
ulcer
ulcer
Page | 41
Peptic ulcer
Peptic ulcer
fatal Peptic ulcer

Fatal
technique
Ulcer ulcer
duodenal ulcer vagotomy
peptic ulcer
concept
 Peptic ulcer is
Peptic ulcer pathology

peptic ulcer clinical pictures
clinical pictures
Pain related to meal
duodenal ulcer
Sesonal variation
Page | 42
Periodicity
Periodicity
gastric ulcer
Pain related to meal
duodenal ulcer
Pain related to meal 50

severe in few weeks
few months
duodenal ulcer
Durinal variation
gastric ulcer variation
seasonal variation
seasonal variation
duodenal ulcer
pain related to meal


Page | 43
seasonal variation
duodenal ulcer
duodenal ulcer
To the right of the mid line
gastric ulcer
Mid line
body fundus
Pylrous
pylrous Ulcer
mid line
duodenum
gastritis peptic ulcer localization
gasteritis

Localization

gastritis
 colitis
Page | 44

localization
peptic ulcer appendicitis localization
Peptic ulcer appendicitis
Peptic ulcer
duodenal ulcer Gastric
pain
complications
complications
perforation Hematemesis
Pain Peptic ulcer

Pain cardinal symptom
vomiting
duodenal ulcer
Induced gastric ulcer
Pain Peptic ulcer
Pain
duodenal ulcer Pain
seasonal variation
gastric ulcer
pain gastric ulcer vomiting
pain duodenal ulcer

complications
Pain duodenal ulcer

complications
perforation Melena hematemesis complications
Page | 45
complications
Peptic ulcer sign

pointing
 peptic ulcer
pointing pain
clinical pictures
pointing pain
Investigations Peptic ulcer peptic ulcer
barium
biopsy
biopsy
gastric ulcer
biopsy duodenal ulcer
never to turn malignancy duodenal ulcer
Potentially malignant
gastric ulcer

May turn malignancy gastric ulcer
 malignant from the start malignant gastric ulcer
biopsy gastric ulcer
Page | 46

biopsy duodenal ulcer
biopsy gastric ulcer peptic ulcer

duodenal ulcer
gastric ulcer biopsy

biopsy accuracy
Ulcer biopsy
98 % accuracy
2%
98 % accuracy
2%
accuracy biopsy
4 biopsies
accuracy
Peptic ulcer
gastric ulcer
biopsy
biopsy
4 quadrant punch biopsy
accuracy
98 %
duodenal ulcer
biopsy
Never to turn malignancy
Medical treatment gastric ulcer
Page | 47
gasterectomy
pathology
acidity
malignancy
Ulcer bearing area outside gastric ulcer
fundus body
Malignant 
gastric ulcer
malignancy 
gastric ulcer
benign 4 quadrant punch biopsy biopsy
2%
Medical treatment
pathology
medical treatment duodenal ulcer
manipulation duodenal ulcer

gastric ulcer
malignancy Iam targeting
duodenal ulcer what is the aim of treatment

healing promot symptoms to relief
what is the aim of medical treatment of gastric ulcer

healing
Page | 48
gasterectomy healing
what is the aim of medical treatment in duodenal ulcer

Healing to promot symptoms to relief
aim of medical treatment of gastric ulcer

Healing
gasterectomy healing
Malignant chances
malignancy
treatment
gastric ulcer
omeprazole gastric ulcer
antacids
ulcer gastric ulcer

by surgery
malignancy
biopsy
Medical treatment
benign
Page | 49
oriented
Oriented
4 quadrants punch biopsy
98 % accuracy biopsies
16 biopsy 8 biopsy
accuracy
Barium
barium
lumen barium
barium barium
Barium
Ulcer
Barium
lumen Barium
depression
barium
depression barium
Lumen barium
ulcer
barium depression
Barium
Niche
Page | 50
Ulcer
Mucosa
Muscle
muscles
Longitudinal fiber Circular muscle fibers
circular
longitudinal Circular HCL

circular
Hour glass circular muscle fiber
Ulcer
ulcer
circular muscle fiber HCL
ulcer Ulcer
Ulcer
Hour glass
X-ray
Plane X-ray
plain X-ray
Hour glass
Ulcer Ulcer
ulcer
Page | 51
Niche Ulcer notch ulcer niche peptic ulcer
depression
barium X-ray
lumen barium
Ulcer constriction
constriction
plain
niche constriction
Ulcer niche Barium

corrosponding to the niche ulcer notch
hour galss
circular muscle fiber spasm ulcer
Fibrosed
fibrosis fibrosis fibrosis Fibrosis
Hour glass stomach
Hour glass stomach

spasm
fibrosis fibrosis fibrosis fibrosis
pouch Pouch
hour glass stomach
ulcer notch Ulcer niche gastric ulcer

hour glass
fibrosis fibrosis fibrosis fibrosis Hour glass

Pouches
gastric ulcer Barium
Page | 52
ulcer notch corrosponding to the ulcer niche Ulcer niche
fibrosis healing
Hour glass stomach
Ulcer
Lateral view
view
barium Ulcer
barium
Ulcer
Post evacuation film

barium
Ulcer
Ulcer
post evacuation film
Post evacuation film
barium
barium
depression barium
stomach rouge
Page | 53
ulcer crater
ulcer crater
post evacuation film
ulcer
ulcer crater
gastric ulcer Investigation

gastric ulcer
malignant chance gastric ulcer
ulcer
4 punch biopsy
98 % accuracy
barium barium Barium

stomach
Post evacuation
ulcer notch Ulcer niche stomach

Ulcer ulcer crater post evacuation
Barium
duodenal ulcer barium
duodneal ulcer gastric ulcer
duodenum
duodneum
barium
gastric
Normal duodenum
pylrous
Page | 54
pylrous
Distensible
collapsed
Distended
pylrous
pylrous
sphincter pylrous
duodenum
duodneum
Collapsed
pylrous duodneum
collapsed
Pylrous duodenum
Distal
collapsed
 first part of duodenal cap
Page | 55
collapsed
duodenal cap
plain
plain
plain
duodenal cap
triangle
angle
peptic ulcer
Constriction
circular muscle spasm
angle angle angle
ulcer niche duodenal ulcer

deformity
defromity duodenal cap
ulcer niche
normal duodenal cap
deformity duodenal cap
Page | 56
Normal duodenal cap

normal duodenal cap
deformed barium
duodenal cap
deformity
Page | 57
Peptic ulcer Investigations

extensive ulcer recurrent ulcer
gastrin
gastrin Peptic ulcer
Peptic ulcer
gastrin
extensive ulcer recurrent ulcer gastrin
Phosphorus
recurrent ulcer
gastrin Phosphorus calcium

recurrent cases
gastrin phosphorus calcium

recurrent cases
peptic ulcer Investigations

endoscopy 
barium 
endoscopy
Recurrent cases phosphorus calcium gastrin

Phosphorus calcium Gastrin
recurrent cases
CBC
chronic blood loss pale
anemia
CBC
Page | 58
Investigations for complications
CBC
investigations for complications
peptic ulcer Investigations

barium endoscopy
gastrin Phosphorus calcium

recurrent ulcer
for anemia CBC

investigations for complications
peptic ulcer
treatment of peptic ulcer

written

surgical Medical
Medical treatment
suclurfate cimtidine Rantidine Omeperazole
antacids
Indications for surgery

vagotomy
gasterectomy

peptic ulcer
Medical main line of treatment
Page | 59
Limited indications
Main line of treatment

Medical
Just indications
Surgery
Medical treatment
Indications of surgery
surgery
Peptic ulcer
Triple therapy
concept
Peptic ulcer
Helicobacter

triple therapy

triple therapy
double therapy triple therapy

We have to eradicate the Helicobacter
medical treatment
Page | 60
Life style
Physical and mental rest stress
triple therapy
double therapy
triple therapy
Omeprazole 
Falgyl 
Clarithromycin 
double therapy
Omeprazole 
erythromycin 
medical treatment
Peptic ulcer
helicobacter Infection
We have to eradicate the Helicobacter

Healing Pormote eradication of Helicobacter
Helicobacter eradication
double therapy Triple therapy
Page | 61
Omeprazole
proton pump inhibitor
Calrithromycin Omeprazole
To eradicate
Helicobacter
triple therapy
Omeprazole
To prevent recurrence
triple therapy
Omeprazole
To prevent recurrence
duodenal ulcer aim of treatment

Healing Promote symptoms To relief
gastric ulcer aim of treatment

healing
gastric ulcer
6
gasterectomy ulcer
treatment duodenal ulcer
Medical treatment of peptic ulcer

Page | 62
Peptic ulcer
medical treatment of peptic ulcer

Cimetidine Rantidine Omeprazole
sucralfate

sucralfate Omeprazole
sucralfate
HCL
HCL Omeprazole
Omeprazole
 sucralfate
Peptic ulcer
Main line of treatment of peptic ulcer
medical
Medical treatment
Helicobacter I want to eradicate
duodenal ulcer aim of treatment

Healing Promot symptoms To refief
Page | 63
aim gastric ulcer

Healing
Other drugs
medical treatment
indication for surgery
surgery
healing gastric ulcer
6 healing duodenal ulcer
hematemesis Perforation complications
Indication for surgery

complications Failure of medical treatment
Indications
Peptic ulcer
100
100
Page | 64

Failure of medical treatment
complications
non compliant patient
simian crease
Non complaint patient
Complaint
non compliant patient

Non compliant
peptic ulcer
Medical
life style
Indications of surgery
complications
surgery
Page | 65
Vagotomy 
gasterectomy 
gasterectomy vagotomy
duodenal ulcer Vagotomy

gastric ulcer gasterectomy
duodenal vagotomy
gastric gasterectomy
gastric ulcer
Pathology
duodenum duodenal ulcer

malignant
malignant duodenum
acidity vagotomy
ulcer
duodenum scar
cancerous scar
vagotomy duodenal ulcer Main line of treatment
acidity Once
ulcer
scar
Pre cancerous scar scar
gastric ulcer
possibility of malignancy
Ulcer
Medical treatment
pathology
Page | 66
gasterectomy
duodenal ulcer gasterectomy

acidity
duodenal ulcer acidity
vagotomy gasterectomy
vagotomy acidity
gasterectomy
complications
vagotomy
gasterectomy
Is high cost for benign condition
is high cost for benign condition gasterectomy

duodenal ulcer gasterectomy
duodenal ulcer
duodenal fistula late dumping early dumping dumping gasterectomy
duodenal stump blowout
benign condition duodenal ulcer

gasterectomy is high cost for a benigng condition
gastric ulcer vagotomy

ulcer
vagotomy
Page | 67
gastric ulcer gastric ulcer

duodenal ulcer vagotomy
surgical treatment
vagotomy duodenal ulcer

gasterectomy gastric ulcer
gasterectomy
G cells
stimulation Parietal cells

Pepsin gastrin
vagus gastrin
HCL
HCL
HCL
HCL HCL

HCL
Infection
HCL
ferrous ferric
HCL
Healing
target
healing
Page | 68
vagotomy
gasterectomy
vagus
gastrin vagus
gasterectomy target
gastrin G cells
G cells
pylrous
pylrous G cells
body parietal cells
pylrous
anterectomy gasterectomy
pylrous
pylrous
pylrous

body fundus
pylrous
pylrous
anterectomy gasterectomy
G cells
ulcer anterectomy anterectomy
body
body
parietal cells vagus
acidity
Parietal cells body
Page | 69
50 %
65 %
partial gasterectomy
Ulcer

acidity
body acidity
85 %
subtotal gasterectomy 85 %
subtotal gasterectomy
Ulcer
partial acidity subtotal gasterectomy

anterectomy acidity partial
gasterectomy
vagotomy
truncal vagotomy vagotomy
vagus trunck
posterior vagus anterior vagus
truncal vagotomy
Posterior vagus anterior vagus
truncal vagotomy
celiac branch Hepatic branch 

crow’s foot 
Page | 70
anterior vagus
anterior nerve of Latarjet hepatic branch
Crow’s foot pylrous
celiac branch Posterior vagus

Posterior nerve of Latarjet
body
vagus trunck
hepatic branch anterior vagus vagus trunck
Crow’s foot
celiac branch posterior vagus
gall stone hepatic branch

gall bladder
biliary dyskinesia
sphincter of Oddi gall bladder

sphincter gall bladder
sphincter gall bladder
biliary dyskinesia
bile
biliary dyskinesia gall stone Hepatic branch
Crow’s foot
Pylrous
pylrous
pylroplasty Pylrous
gastrojejunostomy
crow’s foot
pylrous
pylrous
Pylroplasty pylrous 
Page | 71
gastrojujenosotmy 
celiac branch
constipation distention
bouts of diarrhea
intestine celiac branch
vagus trunck
celiac branch Hepatic vagus
selective vagotomy
celiac branch hepatic vagus
Selective vagotomy
gall stone
celiac branch Hepatic branch vagus

gall stone hepatic
biliary dyskinesia
bouts of diarrhea celiac

pylrous still
crow’s foot
selective
gastrojejunostomy pylroplasty
Truncal vagotomy
diarrhea stones biliary dyskinesia
Selective
Page | 72
crow’s foot
pylrous
gastrojejunostomy plyroplasty
Intestine
diarrhea
celiac branch diarrhea

drainage
diarrhea
drainage
diarrhea truncal vagotomy

celiac branch diarrhea
selective vagotomy
drainage diarrhea
diarrhea
selective truncal
Crow’s foot
Pylrous
Highly selective vagotomy

body branches
celiac Hepatic
crow’s foot
body
crow’s foot body
anatomy
Crow’s foot
branches
notch lesser curve
Pylrous body
Page | 73
pylrous
pylrous
gastrojejunostomy pylrous
pylroplasty
Highly selective
selective truncal highly selective
selective vagotomy truncal vagotomy

diarrhea mainly
highly selective selective
diarrhea
apparaently
crow’s foot hepatic celiac

branches
small vessels branches
 vessel nerve
vessel Nerve
Lesser curve necrosis
Highly selective vagotomy

Lesser curve necrosis
an avoidable
Nerves vessels
fat
Page | 74
Lesser curve necrosis Highly selective vagotomy

Lesser curve nerves
branches
highly selective vagotomy
branches
branches
Lesser curve
Lesser curve vessels nerve
lesser curve
lesser curve blood vessel
seromyotomy
highly selective vagotomy seromyotomy
lesser curve Necrosis
written
written
Medical treatment
Main line of treatment
Helicobacter eradicate

surgery
gasterecotmy 
vagotomy 
gasterectomy
Anterectomy 
Partial gasterectomy 
Subtotal gasterectomy 
vagotomy
Page | 75
Truncal vagotomy 
selective vagotomy 
selective truncal
drainage procedure
seromyotomy Highly selective

drainage procedure
treatment of complication
treatment of
complications
treatment of complications
peptic ulcer
complications
written question
treatment Treatment of peptic ulcer
Treatment of complications
written
written question summary of treatment of peptic ulcer
written question
details
gasterectomy detalis
vagotomy
gasterectomy details
drainage procedure
details gasterectomy
Page | 76
Pylroplasty
Pylrous
pylrous
pylroplasty
Pylrous
posterior wall anterior wall
pylrous
plyrous
anterior wall
Posterior wall
anterior wall
pylrous
patulous
pylroplasty
pylrous
 duodenum
diarrhea
diarrhea diarrhea
How ever
Page | 77
truncal vagotomy diarrhea

diarrhea selective vagotomy truncal vagotomy
Peptic ulcer
perforation bleeding pain Peptic ulcer

diarrhea
Peptic ulcer
Mikulicz pylroplasty
duodenum pylrous
pylrous bypass
pylroplasty
Mikulicz
fibrotic pylroplasty
fibrosis medical treatment ulcer
pylrous fibrosis
pylroplasty pylrous fibrosis
gastrojejunostomy
gastrojejunostomy pylrous fibrosis
gastrojejunostomy
Page | 78
complications cancer
gastrojejunostomy
Jujenum
gastrojejunostomy
Non anatomical
duodenum bypass
duodenum
GIT hormones stimulation duodenum

GIT hormones
gastrin cholecystokinine
GIT hormones duodenum
GIT hormones
bile
bile
pancreatic juice bile duodenum To bypass

malabsorption
Maldigestion and malabsorption
gastrojejunostomy
duodenum bypass
duodenum calcium
duodenum bypassing
osteomalacia
gastrojejunostomy Plyroplasty
anatomical pylroplasty
normal anatomy
Page | 79
anatomical pylroplasty
normal anatomy
duodenum
gastrojejunostomy
inestine diarrhea
pylroplasty
GIT hormones
conculsion
truncal vagotomy
pylroplasty
gastrojejunostomy
pylrous fibrosis
pylroplasty
gastrojejunostomy
gastrojejunostomy
antiperistalsis gastrojejunostomy
inestine peristalsis
intusssception
anti peristalsis gastrojejunostomy
intestine stomach
Intusssception
Intestine
stomach intestine peristalsis
gastro-jejunostomy Jejunum
stomach intestine peristalsis
gastro-jejnostomy
Iso peristalsis
Page | 80
anti perstalsis gastrojejunostomy
anti perstalsis Perstalsis
Posterior wall of the stomach anterior wall of the stomach jejunum

posterior wall of the stomach
More dependant Posterior wall of the stomach
more dependant Posterior wall of the stomach
resistant for medication redundant loose posterior wall of the stomach
anterior wall of the stomach

posterior wall anterior wall stomach
cross section stomach

posterior wall anterior wall
posterior wall More dependant
lesser sac stomach

lesser sac stomach
lesser sac
resistant for medication redundant Loose Stomach
dependant
posterior iso perstalsis gastrojejunostomy

posterior iso perstalsis gastrojejunostomy
Page | 81
transverse colon transverse colon jejunum
colon colon Jejunum

stomach
transverse colon
Intestine
retrocolic posterior iso perstalsis gastrojejunostomy

MCQ
all of the above
retrocolic posterior iso perstalsis gastrojejunostomy
duodenal ulcer
Medical
Medical treatment
Life style attack
healing promote symptoms Relief aim of treatment
indication for surgery

complications
Vagotomy
selective vagotomy truncal vagotomy
drainage procedure
seromyotomy Highly selective vagotomy

drainage procedure
Page | 82
truncal vagotomy
drainage procedure selective vagotomy
pylroplasty
gastro-jejunostomy
deformed fibrotic pylrous
gastrojejunostomy gastro-jejunostomy
retro colon iso perstalsis Posterior
gasterectomy
gasterectomy
gasterectomy
anterectomy
partial 65 %
subtotal 85 %
gasterectomy
gasterectomy Billroth 2 Billroth 1

gasterectomy
gasterectomy
Anterectomy 
Partial gasterectomy 
Subtotal gasterectomy 
gasterectomy
Billroth 2 Billroth 1
Page | 83
gasterectomy
stomach duodenum
duodenum
duodenum
Billroth 1
duodenum Anatomical
GIT stimulation
absorption of calcium
Billroth one

duodenum duodenum 
retro peritoneal duodenal Posterior abdominal wall
loose duodenum
duodenum
duodenum
gravity

Page | 84
inestine
anastomosis
HCL Bile
peritonitis
angle of sorrow
Billroth one
duodenum
anastomosis
peritonitis
angle of sorrow
Billroth one
Billroth 1
duodenum stomach
duodenum stomach
gastro-jejunostomy
dependant posterior iso perstalsis gastro-jejunostomy
retro colic
Page | 85
stomach gastro-jejunostomy
drainage
Billroth 2 Billroth 1 Billroth
Billroth 2
Billroth one Billroth
Billroth 2
drainage
Billroth
duodenum
stomach Jejunum jejunum
duodenum
jejunum
Over drainage drainage
Jejunum
jejunum
late dumping early dumping dumping
Billroth
 over tafreegh
www.facebook.com/dr.tafreegh
jejunum
valve
Page | 86
intestine
with a valve
with a valve
duodenum
duodenum
duodenum
Blind loop
duodenum 
repeated gastro entritis

vitamin D consume
bacterial over growth blind loop

Vitamin D consumption
repeated gastro enterititis
with a valve
blind loop
Post gasterectomy complications
dumping
Late dumping early dumping
gastro jejuno-colic fistula
Page | 87
duodenal stump blow out and fistula
gastric ulcer gastric ulcer
failed medical treatment
Gasterectomy
Gastric ulcer
symptoms recurrent few months

severe diarrhea severe vomiting

very bad general condition
recurrent symtpoms Dumping
recurrent of symptoms
Ulcer

Page | 88
IQ ulcer
Ulcer

Ulcer
ulcer
gasterectomy
Ulcer
colon
suture line Ulcer
colon
colon Jejunum stomach
Gastro-jejuno colic fistula
gastro jejuno colic fistula

Gastric ulcer
gastric ulcer
medical treatment
medical treatment
gasterectomy
medical treatment gastric ulcer 

gasterectomy
gasterectomy
Page | 89
symptoms recurrent
recurrent ulcer
recurrent ulcer
Ulcer
diarrhea Severe vomiting
diarrhea severe vomiting
anus Mouth GIT

mouth anus
bacterial load
stool
gastroenteritis
bacterial load
E.Coli
Severe gastritis
vomiting
Page | 90
Jejunum
jejunum
bacterial load
intestine jejunum
Intestine colon
colon ileum jejunum duodenum bacteria

bacterial load
severe gastroenteritis Jejunum
diarrhea
small intestine Diarrhea

colon
diarrhea
very bad general condition


gastro jejuno colic fistula Interested
gastric ulcer
medical treatment
failed
gasterectomy
complications of gasterectomy
Page | 91
gastric ulcer
medical treatmetn
failed
gastro jejuno colic fistula recurrence
Complication
diarrhea vomiting
gastroenteritis diarrhea vomiting

sequences of events
complications
complications
enema barium enema barium meal

barium meal
colon barium barium meal
colon Intestine barium
Barium enema
barium
fistula
barium enema More confirmatory

barium meal
barium enema More confirmatory

barium meal
Page | 92
Resuscitation
Colostomy
fistula fistula colostomy

fistula
fistula fistula
colostomy
fistula colostomy
resuscitation
colostomy
enema
Infection
proximal colostomy
proximal colostomy
diarrhea vomiting
fistula
Page | 93
gasterectomy
gasterectomy fistula
gasterectomy
recurrent ulcer
gasterectomy
fistula gasterectomy
complications
late dumping early dumping
early dumping
⅓
late dumping
early dumping
early dumping
gasterectomy
complications
gasterectomy
⅓ Pain related to meal
Page | 94
gasterectomy
complications
gastric ulcer
⅓
gastric ulcer
complications
post gasterectomy complications



early dumping
late dumping
Post gasterectomy complications

Early dumping
Cause of this problem cause
Page | 95
hypo volemia
How to manage this case
small frequent
with a valve gasterectomy failed
spelling
anatomy gasterectomy
generalized peritonitis Perforated peptic ulcer

chronic perforation penetration
Liver
Liver gastric ulcer
pancreas duodenal ulcer
Late dumping early dumping
with a valve gasterectomy
Intestine loop
Jejunum Loop
Perstalsis
Page | 96
Perstalsis
perstalsis
40
20 Loop
delay of emptying Anti perstalsis
delay emptying of the stomach
with a valve valve

reverted jejunal loop
gasterectomy
Late dumping
late dumping
Hypo glycemia
Hypo volemia early dumping 

hypo glycemia late dumping 
hypo volemia early dumping

hypo glycemia late dumping
hypo volemia early dumping

hypo glycemia late dumping
hypo volemia hypo glycemia
Page | 97
gasterectomy
intestine
intestine
intestine
Intestine
gasterectomy failed medical treatment gastric ulcer 

gasterectomy
Jejunum
jejunum Gasterectomy
Jejunum
jejunum
pylrous
Jejunum
Jejunum
Page | 98
gasterectomy
pylrous
jejunum



intestine
intestine glucose
absorption
absroption
absorption
gasterectomy

absorption
hyper tonic solution

intestine
early dumping
gasterectomy
Inestine
absorption intestine
hyper tonic solution
semi permeable membrane
Page | 99
early dumping
late dumping
 intestine
intestine
gasterectomy
intestine
intestine intestine
Intestine
rebound hypo glycemia

intestine early dumping
late dumping

late dumping
complications
Page | 100
duodenal fistula
duodenal fistula
fistula duodenal stump gasterectomy

blow out
Fistula
duodenal fistula
gasterectomy duodenal fistula
duodenal stump
fistula
fistula blow out
 duodenal fistula
pancreatic juice bile
Fat
macerated excoriated
High output fistula
Page | 101
duodenal stump
duodenal fistula
secretion
suction
skin maceration zinc oxide
Omentum fistula peritonitis
electorlyte imbalance dehydration

high output
Water and electrolyte imbalance
dehydration
High output fistula
duodenal fistula
High output fistula duodenal fistula
electrolyte imbalance dehydration

excoriation skin maceration
conservative duodenal fistula

suction
total parentral nutrition zinc oxide

 follow up
follow up conservative
Page | 102
follow up
follow up
2
1500
1000
total parentral nutrition

conservative some suction zinc oxide electrolyte fulid
follow up
2
2
2
total paretral nutrition for life
fistula
gasterectomy
Revise
MCQ
revise it
fistula gasterectomy Revise
ringer
acidosis ringer lactete
Page | 103
duodenal fistula duodenal stump blow out
post gasterectomy complications

duodenal stump blow out and duodenal fistula
late dumping early dumping Dumping


⅓
constipation vomiting colic abdominal distention 3
intestinal obstruction
3
adhesions
adhesion intestinal obstruction
fluid catheter Line Ryle
24
Failed
adhesion
recurrent
Page | 104
complications
peptic ulcer complications
Complications of peptic ulcer

stress ulcer
stress
non steroidal anti inflammatory ulcer
ulcer
Ulcer
Non steroidal anti inflammatory
Ulcer
ulcer
stress
non steroidal anti inflammatory
spicy food
Page | 105
HCL
ulcer
melena hematemesis
Ulcer
factors
peptic ulcer bleeding
spicy food non steroidal anti inflammatory stress
Perforated peptic ulcer

spicy food Non steroidal anti inflammatory stress
bleeding
perforation
Tissue response to irritant
Irritant fat
Irritant HCL
within 48 Ulcer
omentum
generalized peritonitis
48
omentum
Mass
Page | 106
subacute acute perforation
48 activity
48 activity
mass omentum
peri gastric mass
fibrotic serosa
Liver
pancreas duodenum
liver HCL
ulcer
duodenum
duodenum
periton simple HCL Ulcer
Ulcer
HCL
chronic perforation
Page | 107
generalized peritonitis 48
Mass 48
Peritonitis Organ
Peritonitis chronic perforation
generalized peritonitis acute perforation
sub acute perforation

Mass
peritonitis
localized
mass appendicitis
Peritonitis Mass
Localized
generalized peritonitis 48
Localized peritonitis 48
bile HCL Peritonitis
Organ
Liver 
pancreas 
peptic ulcer
spicy food stress non steroidal anti inflammatory
48
Generalized peritonitis
Periton
chemical peritonitis bile HCL
Page | 108
peritonitis
vaso dilation
cellular element fluid element
toxins dilution fluid element
HCL bile dilution
peptic ulcer
 
Quiescent stage
Quiescent stage
general condition Pain
pain
dilution fulid
fulid
generally
quiescent stage
Page | 109
stasis fluid
followed by infection stasis
septic phase stage of septic peritonitis
toxic
Perforated peptic ulcer

3
Chemical peritonitis 
Quiescent stage 
Septic phase 
septic
pain
Generalized
pain
stage
septic phase chemical phase
Quiescent stage Pain
disturbance of function
Function of
Peritonitis  GIT GIT
Peristalsis
peristalsis
constipation vomiting
time
septic phase
Page | 110
signs
inspection loca
Rigidity
superficial palpation
Guarding
deep palpation
Tenderness and rebound tenderness
Percussion
Shifting dullness
auscultation
Diminished intestinal sounds
PR
fluids air Douglas pouch Fullness
shifting dulness Percussion

 free PR
Douglas pouch shifting dullness
Douglas pouch fullness ascites
rupture spleen rupture ectopic pregnancy

Hemoperitoneum rupture liver
Douglas pouch fullness
Local examination
examiner
Diminished liver dullness
Page | 111
Perforated
Investigations acute perforated peptic ulcer

plain X-ray Ultra sound
aspiration
Peritonitis
aspirate aspiration ultra sound
Pus bile
Peritonitis
Plain X-ray abdomen erect

air under diaphragm
Peptic ulcer Investigations

endoscopy Barium meal
perforated peptic ulcer investigations

plain X-ray erect Ultra sound
peptic ulcer
Peritonitis
gastrographin
perforation dye escape
Investigation
gastrographin
gastrographin
pus fluid fluid
Page | 112
air under diaphragm plain X-ray abdomen erect

perforated peptic ulcer perforated appendix
Peptic ulcer
generalized peritonitis perforated peptic ulcer

Resuscitation
Pus
duodenum
Medical duodenal ulcer

complications
pylroplasty Indication for vagotomy
complications
Medical
pylroplasty vagotomy
duodenal ulcer
Medical
perforation complications
pylroplasty vagotomy
Pylroplasty
duodenum
Pylroplasty
pylroplasty
Pylroplasty vagotomy
general condition
Omentum
Page | 113
Omentum 48
omentum
Omentum
Omentum HCL Omentum
fibrosis Healing HCL omentum
fibrosis Omentum
Omentum
50 %
medical treatment 25 %
vagotomy 25 %
vagotomy 75 % Omental patch
gastric ulcer
Gasterectomy
complicated gastric ulcer
bad general condition

Omental patch
biopsy
biopsy Omental patch
Possiblity of malignancy


gastric ulcer
Page | 114
omental patch biopsy general condition
sub acute perforation

Mass
pain
severe
constipation vomiting
Peritonitis
constipation vomiting peristalsis peritonitis 
Ultra sound
Ultra sound appendicular mass
ultra sound appendicular mass
Omentum
appendicular mass
sonar
sonar

mass
Oschner Sherren’s
fluid catheter Line Ryle
antacid
Page | 115
Waiting for what

omentum
Omentum
ulcer
fibrosis Ulcer 
Omentum

Pylroplasty vagotomy duodenal ulcer
Mass 19
Omentum conservative
Ultra sound Mass investigations of choice 15

Ultra sound generalized peritonitis
Ultra sound peritonitis
Problem omentum
gastric ulcer duodenal ulcer
abscess Perigastric mass

Aspiration guided by ultra sound
Mass
Omentum
Page | 116
chronic perforation
chronic perforation
Peritonitis
peritonitis Mass
acute perforation
Generalized
Mass
Localized
chronic perforation
peritonitis
Peritonitis
HCL
Peptic ulcer
pancreas
medical treatment duodenal ulcer
change of character of pain is means complications

It means complications character of pain change
chronic perforation
chronic perforation Pancreatic pain
Page | 117
medical treatment
abdomen Mass
pulsationseptic mass
Knee chest position
knee chest position Pulsation
pseudo pancreatic cyst
Peptic ulcer pseudo pancreatic cyst
pancreatitis
fluid pseudo pancratic cyst

Lesser sac
Peptic ulcer pseudo pancreatic cyst
Peptic ulcer
Incidence

 peptic ulcer

pancreatitis pseudo pancreatic cyst

pseudo pancreatic cyst pancreatitis
Peptic ulcer psuedo pancreatic cyst
chronic perforation
pylroplasty Vagotomy
Pylroplasty vagotomy
Page | 118
Ulcer
pancreas
HCL
vagotomy
HCL
healing Ulcer
pentrating peptic ulcer 

duodenum
duodenum
duodenum
blood supply
blood supply duodenum
Ulcer plyroplasty vagotomy
bleeding peptic ulcer hematemesis


Bleedin peptic ulcer

ulcer HCL
Page | 119
Ulcer
amount of bleeding granulation tissue

medium sized vessel
severe bleeding gastro duodenal artery
gastro duodenal artery

severe bleeding
Peptic ulcer bleeding

posterior ulcer anterior ucler

Posterior ulcer
anterior ulcer
MCQ
Posterior ulcer 
anterior ulcer 
para colic gutter fluid Ulcer

right iliac fossa
acute appendicitis pictures simulating
appendicitis
Peptic ulcer
para colic gutter fluid duodenal ulcer
right iliac fossa
pictures simulating acute appendicitis
para colic gutter fluid anterior ulcer

right iliac fossa
Page | 120
acute appendicitis Pictures simulating

acute perforation
Ulcer
Posterior ulcer
Peptic ulcer clinical pictures

pain related to meal peptic ulcer
melena
Peptic ulcer
hepato spleno megaly
esophageal varices 
Peptic ulcer 
gastrin Liver Hepato spleno megaly Once
Hyper acidity Liable
bright red per anal

melena per anal
bright red vomiting

acid hematin coffee ground
Peptic ulcer
Page | 121
serosa
periton
rebound tenderness rigidity

guarding
 IQ
air under diaphragm plain X-ray abdomen erect hematemesis
Investigation of choice bleeding peptic ulcer

Endoscopy
endoscopy
angio
barium
 
bleeding peptic ulcer

Resuscitation
omeprazole resuscitation
complications
omeprazole cold antacid cold saline gastric lavage resuscitation
acute peptic ulcer
gastro duodenal artery Unless
severe bleeding
Page | 122
absolute
atherosclerosis
recoil of blood vessels atherosclerosis
resuscitation complications
complications hematemesis
Omeprazole cold saline Resuscitation

omeprazole cold saline Resuscitation
Indications
Old age recurrent bleeding Severe bleeding
bleeding
gastric ulcer
Gasterectomy
duodenal ulcer
pylroplasty Vagotomy
bleeding Pylroplasty
Pylroic stenosis
Pylroic stenosis
Pylroic stenosis
duodenal ulcer
duodenal ulcer
Medical treatment
Medical
double therapy Triple therapy
medical treatment
medical treatment
Page | 123
medical treatment
Change of character of pain
complications
Change character of pain it means complications
change character of pain
chronic perforation
rigidity guarding
acute perforation
change of charatcter of pain
vomiting by the end of the day change of character of pain
pylroic stenosis 
food of the previous day
food of the previous day

Pylroic obstruction
Pylroic obstruction
Page | 124
generalized lowered abdomen
generalized lowered abdomen duodenal ulcer

acute perforation
chronic perforation duodenal ulcer
pylroic obstruction duodenal ulcer
Gastritis
gastritis
gastritis
pylrous healing by fiborsis duodenal ulcer

dilated
under weight
bad chest
Vomiting
HCL
dehydrated
Page | 125
kidney
hydrogen
Paradoxical aciduria
alkalosis
Investigation Pylroic stenosis
vomiting History
Pylroic stensosi
dilated Stomach


congenital hyper torphy pylroic stenosis CHPS
not done now


Not done now
history pylroic obstruction
Page | 126
History pylroic obstruction

examination
dilated stomach examination
not done now
Investigation
Barium
stomach
L3
L3 stomach
stomach
6 5 4
L6
L6
L3 Stomach
L5 L4
Pelvis
barium
barium
rouge
soap dish appearance
soap dish appearance
pylrous
cancer pylrous pylrous biopsy
pylroic obstruction cancer pylrous
Page | 127
biopsy cancer pylrous
pylroic stenosis
Resuscitation
Saline
Pylroplasty vagotomy duodenal ulcer


pylroplasty deformed plyrous

gastro jejunostomy vagotomy
gastro jejunostomy
retro colic Posterior Iso peristalsis
hour glass stomach fibrosis healed medical treatment gastric ulcer
Pouch Pouch
vomiting
Vomiting at the end of the day
Hour glass stomach

gasterectomy Resuscitation
gasterectomy
gastric ulcer
pouch gastro jejunostomy
Page | 128
Pouch gastro jejunostomy
IQ
ulcer
potentially malignant gastric ulcer
excise it
gasterectomy
ulcer bearing area
recurrent ulcer
www.facebook.com/dr.tafreegh
Page | 129

13 - 14 Stomach

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

13 - 14 Stomach

Uploaded by

Copyright:

Available Formats

Stomach - Dr.

pyloric stenosis pyloric obstruction

acute condition Pyloric obstruction

acute condition obstruction

hypertrophy thick pyloric sphincter

Pyloric sphincter hypertrophy

congenital hypertrophic pyloric stenosis

under weight pathology

bad chest Under weight

hypo nateremia dehydration

positive ions kidney

hypo kalemia Hypo natremia dehydrated

fades gradually towards the stomach Hypertrophy

intestinal obstruction Projectile vomiting

acute condition volvulous neonatorum

severe colic severe abdominal distention volvulous neonatorum

bile stained vomiting volvulous neonatorum

Not bile stained

Not bile stained

upper abdominal distention

He doesn’t get weight

He doesn’t get weight

circular muscle fiber

Repair with interrupted sutures and reinforced by omental patch

limited Medical treatment role

Medical treatment Indication

medical treatment Indication written

acute peptic ulcer

ultra sound gastrographin

gastrographin saline sonar

delayed emptying dilated stomach barium

delayed emptying dilated stomach

acute peptic ulcer

pepsin pepsinogen Stomach Peptic

Due to gastric juice

circular muscle fiber

longitudinal muscle fibers

due to gastric juice Ulcer

duodenum gastric juice HCL

peptic juice duodenum gastric juice

Zollinger Ellison syndrome

Ulcer Chemical irritant

Inflammatory ulcer Chemical irritant

Chemical irritant Peptic ulcer

fibrosis Healing granulation tissue chronicity

chronic acute ulcer

chronic acute ulcer

acute peptic ulcer

rupture humerus rupture clavicle

stress Poly traumatized patient Burn

Cushing ulcer stress ulcer

Multiple small minute ulcers

multiple small minute ulcers

acute gastric erosion

acute peptic ulcer

rebound tenderness rigidity guarding

shifting dullness rebound tenderness rigidity guarding

Barium + Bleeding equal

local examination general examination symptoms

acute peptic ulcer

fluid catheter line ryle

Mucous membrane acidity

cold antacids cold saline ryle wash