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Ulcer disease of the stomach and duodenum

Ulcer disease of the stomach and duodenum. Sceletothopy of the stomach and duodenum. Synthopy of the stomach. Anatomical parts of the stomach. X-ray forms of the stomach. X-ray picture of the stomach. Ligaments of the stomach. Blood circulation of the stomach. Innervation of the stomach.

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Ulcer disease of the stomach and duodenum

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  1. Ulcer disease of the stomach and duodenum

  2. Sceletothopy of the stomach and duodenum

  3. Synthopy of the stomach

  4. Anatomical parts of the stomach

  5. X-ray forms of the stomach

  6. X-ray picture of the stomach

  7. Ligaments of the stomach

  8. Blood circulation of the stomach

  9. Innervation of the stomach

  10. View of the mucous of the stomach

  11. Erosion – superficial defect of the mucous layer Mucous layer Submucous layer Muscle layer Serous layer Ulcer - deepdefect of the mucous layer Mucous layer Submucous layer Muscle layer Serous layer

  12. Endoscopic picture of the acute and chronic ulcer Acute ulcer Chronic ulcer

  13. Spreading of the UDS and duodenum Frequency of the revealing of the UDS and duodenum UDD more frequently appears at young men UDS more frequently appears at men elder than 50 years

  14. Ulcerogeneous factors • Innate plurality of the parietal cells, specific reactivity of the nervous system, 1 group of blood • Stress hypergastrosis: profession; psychic trauma; burn, sepsis. • Functional insufficiency of the stomach: increasing of the acid-peptid secretion, methaplasy of the mucous • Antroduodenal dysmotoric: speed evacuation, gastrostasis, duodenogastral reflux • Breach of the feeding regime: chrinic hungry • Medicines: aspirin, indometacin, glucocorticoids, • Endocrine breaches: hypoglicemy, pancreatitis, Zollinger-Ellison’s syndrome, adenoma of the hypothyroid gland, adenoma of pituitary gland, adenoma of the suprarenal gland • Chronic diseases of liver (cirrhosis): breach of the activation of histamine, gastrin, changes of the contention of the mucous of the stomach. • Diseases of kidneys: hypergastrinemy, hypercalciemy, methabolic acidosis; uremic intixication

  15. = Factors of protection Factors of agression • resistance of the wall of the stomach • of the antoduodenal part • Alkaline secretion • Food • Pepsin and acid(НСl) • Gastroduodenal dysmotoric • Defeats of the mucous

  16. Complaints Main • Pain in the epigastria Additional • heartburn • Sickness, retching • Digestive breaches • Belch

  17. Pain • character:pulling, cutting, fighting • localization: epigastria • irradiation: lumbar area • Connection with the feeding: directly connected

  18. Character of the pain depend on localization (ulcers of the stomach and duodenum)

  19. Objective examination Without specific signs • Asthenic type • Breaches of the vegetative functions: hypotony, bradicardia, increased perspiration • At the beginning of the disease – increasing of the appetite with the purpose of reduction of pain, than fast sliming • Tongue is covered by white raid • Hungry and night pain • Pain and muscles effort at the right superior quadrant of the abdomen Basically

  20. Special methods of the research • EGDFS • X-ray • Рн - metry • Research of the gastric juice

  21. Ulcer

  22. Research of the gastric juice

  23. Differential diagnistic • Tumor of the stomach • Acute and chronic cholecystitis • Acute and chronic pancreatitis • Acute appendicitis

  24. The principles of treatment of the UDS and duodenum • conservative(2once a year) • diet • spasmoliticsи (no-shpa, papaverin, platyphullon) • Н2-blockers (zantak, trisil, cimetidin, ranitidin, cvamatel) • Envelopping drugs (almagel, maalox, gastrine gel) • Н+ protone pomp blokers (omeprasol) • vitominotherapy • Antochelicobacter therapy (trochopol, roxin) • Operative (palliative and radical) • Not effective cobservative therapy • Complicated ulcer disease • Frequent recidives Ulcer disease of the stomach – surgical treatment

  25. Accesses, using for the stomach and duodenum

  26. Mobilization of the stomach by the big curvature

  27. Resection of the stomach

  28. Bilrot 1 and Bilrot 2

  29. Finishing stage of the operation Bilrot-II Bilrot-I

  30. Pyloroplastic by Geyneke-Mikulich

  31. Localization f the ullcers, thaat are the indications to the laparoscopic resection of the stomach by Bilrot 1 1 and 2 - I type; 3 - III typeby Johnson.

  32. Points of the entering of the troacars at the laparoscopic resection of the stomach by Bilrot 1

  33. Fixation of the cult of the duodenum and stomach 1 – sewing of the anterior walls by the small curvature 2 - sewing of the anterior walls by the big curvature 3 – fixation of the anterior wall of the stomach and duodenum by the all lines to the touch of herniostapler.

  34. Gastro- and duodenotomy for the formation of the gastroduodenoanasthomosis by the sewing apparates

  35. Formation of the gastronteroanastomosis with the help of Endo GIA-30. 1 - бранши сшивающего аппарата введены в просвет органов (схема); 2 - аппарат закрыт перед прошиванием и пересечением тканей

  36. Formation of the gastronteroanastomosis with the help of swing apparates. 1 – the type of the anasthomosis after taking sewing apparateвид анастомоза после извлечения сшивающего аппарата 2- sew of the defect of the wound with the help of Endo Stitch

  37. The type of the formed gastroeneteroanasthomosis 1 - scheme; 2 - photography

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