#Peptic_ulcer

Definitive surgery of the ulcer is:

🔴mandatory in bleeding Duodenal ulcer

🔴Optional in bleeding gastric ulcer

🔴Optional in perforation according to general condition of the patient.

Notes on bleeding
🔴M.C complication in Pu ➡️ Bleeding

🔴M.C cause of UGIB ➡️
variceal

🔴2nd M.C cause of UGIB ➡️ Erosive gastritis

🔴M.C artery to bleed in Posterior wall duodenal ulcer ➡️ Gastrtodudonal artery and in gastric ulcer ➡️ left gastric artery

🔴Rx of Bleeding PU
1) Antishock measures
2) IV PPI bolus ➡️ 80mg then maintenance ➡️ 8mg /hour
3) Injection of diluted Adrenaline ( 1:10000) & Haemoclips
4) Failure Endoscope ➡️ Emoblization of feeder vessel
5) Surgery last choice (Definitive ulcer curing surgery is mandatory)

Notes on PU in IM
🔴M.C cause of PU ➡️ H.pylori
🔴M.C cause of DU ➡️ H.pylori
🔴2nd M.C cause of PU ➡️ NSAIDs
🔴M.C cause of GU ➡️ NSAIDs
🔴M.C of bleeding PU ➡️NSAIDs

🔴Gastric ulcer ➡️ malignant from the start
🔴Duodenal ulcer➡️ never turn malignant in

🔴diagnostic test in H.pylori➡️ Urea Breath test (non invasive )
🔴 never follow up by serology

🔴Best line of Rx ➡️ Triple Therapy
Duration of Rx ➡️ 10_14 d

🔴Role ➡️ DU treated for 4 wks & GU for 8 wks

Perforated PU
🔴 gold Ix ➡️ plain x_ray ➡️ Air under diaphragm
🔴 Rx ➡️ Surgical ER to deal with perforation but ulcer curing surgery is optional according to general state of the patient

GOO
🔴Vomiting ➡️ non bilious
🔴best ix ➡️ Endoscopy (to exclude malignancy by biopsy)
🔴DD OF GOO ➡️ cicatrized DU (M.C of this presentation )
🔴Rx ➡️ laparotomy, truncal vagotomy and Gastrojejunistomy

🔴Penetration in PU ➡️ Rx by Gastrectomy

MCQ on complications of Gastric surgery

🔴 Recurrent ulcer
🔴 Small stomach $
🔴 bilious vomiting ( more with bill roth 1)
🔴 Dumping ( early or late )
🔴 post vagotomy diarrhoea
🔴 Malignant transformation ( stump carcinoma)
🔴Metabolic ➡️ IDA ( M.C complication)


🔴 Complications are more with Bill Roth 2 ➡️لأنها بعيدة أوى عن الاناتومى مقارنة ب bill roth 1

🔴 Blow out ( rupture of the stump) ➡️ M.C cause of Death following gastrectomy

Risk signs in Endoscope :
a. Visible vessel (blue or red)
b. Spurter (arterial)
c. Overlying adherent clot
d. Red or black spot in the base of the ulcer

Goiter

PHTN
أهم النقط كلام د سامر البسة فى الجراحة

Management of HCC

M. C goiter iodine def
2nd hashimoto
3rd graves

M. C enzyme def.. Peroxidase
Dyshormonogenesis is autosomal recessive

Rarest malignancy in thyroid lymphoma

Marine leenhart syndrome.. Graves+nodules:
Type 1: +one hyper func nodule
Type 2: + multiple hyper
Type 3: + multiple hyper and hypo

Pendred disease: dyshormonogenesis goiter plus deafness

Us of nodule;

Benign: fully cystic

Very low risk: spongy >50% cystic
Low risk: hyper or iso echogenecity
High risk: hypo or very hypo
Very high risk: achogenic, taller than wider, irregular borders, microcalcification, extrathyroidal extension, lymph node

Biopsy required for thyroid nodule if:
Benign:no
Very low risk>2cm
Low risk>1.5cm
Intermediate+high risk>1cm