1 / 57

DISEASES OF THE OPERATED STOMACH

DISEASES OF THE OPERATED STOMACH. PYLORUS. Distal muscular loop ; Proximal muscular loop. AGGRESSIVE FACTORS. hydrochloric acid pepsin reverse diffusion of ions of hydrogen products of lipid hyperoxidation. DEFENSE FACTORS. mucus and alkaline components of gastric juice

asha
Download Presentation

DISEASES OF THE OPERATED STOMACH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DISEASES OF THE OPERATED STOMACH

  2. PYLORUS Distal muscular loop; Proximal muscular loop.

  3. AGGRESSIVEFACTORS • hydrochloric acid • pepsin • reverse diffusion of ions of hydrogen • products of lipid hyperoxidation

  4. DEFENSEFACTORS • mucus and alkaline components of gastric juice • property of epithelium of mucous tunic to permanent renewal • local blood flow of mucous tunic and submucous membrane

  5. PATHOMORPHOLOGY • erosion • acute ulcers • chronic ulcers

  6. CLASSIFICATION by Johnson (1965) • I – ulcers of small curvature (for 3 cm higher from a goalkeeper); • II– double localization of ulcers simultaneously in a stomach and duodenum; • III – ulcers of goalkeeper part of stomach (not farther as 3 cm from a goalkeeper)

  7. CLINICAL MANAGEMENT • Pain • Vomiting • Heartburn • Belching

  8. COMPLICATIONS • Penetration • Stenosis • Perforation • Bleeding • Malignization

  9. DIAGNOSIS PROGRAM • 1. Anamnesis and physical examination. • 2. Endoscopy. • 3. X-Ray examination of stomach. • 4. Examination of gastric secretion by the method of aspiration of gastric contents. • 5. Gastric pH metry. • 6. Multiposition biopsy of edges of ulcer and mucous tunic of stomach. • 7. Gastric Dopplerography. • 8. Sonography of abdominal cavity organs. • 9. General and biochemical blood analysis. • 10. Coagulogram.

  10. X-Ray examination THE DIRECT SIGNS: • symptom of “Haudek's niche” • ulcerous billow and convergence of folds of mucous tunic. INDIRECT SIGNS: • symptom of “forefinger” (circular spasm of muscles) • segmental hyperperistalsis, • pylorospasm, • delay of evacuation from a stomach • duodenogastric reflux • disturbance of function of cardial part (gastroesophageal reflux).

  11. SYMPTOM OF “Haudek's niche”

  12. STENOSIS OF THE GASTRO-ENTERO-ANASTO-MOSIS

  13. GASTROSCOPY

  14. DEVICE FOR GASTRIC DOPPLEROGRAPHY

  15. Endoscopic picture of the normal stomach wall

  16. Endoscopic picture of the peptic ulcer

  17. SURGICAL TREATMEN • at the relapse of ulcer after the course of conservative therapy; • in the cases when the relapses arise during supporting antiulcer therapy; • when an ulcer does not heal over during 1,5–2 months of intensive treatment, especially in families with “ulcerous anamnesis”; • ulcer with complications (perforation or bleeding); • at suspicion on malignization ulcers, in case of negative cytological analysis.

  18. Classification of the postgastrectomy syndromes • Functional disturbance. • Dumping. • Hypoglycemic syndrome. • Postgastrectomy (agastric) asthenia. • Syndrome of small stomach. • Syndrome of afferent loop (functional origin). • Gastroesophageal reflux. • Alkaline reflux-gastritis. • Organic disturbances. • Pepticulcer of anastomosis. • Gastro-colon fistula. • Syndrome of afferent loop (mechanical variant). • Cicatricial deformation and narrowing of anastomosis. • Mistakes in the technique of operation. • Postgastrectomy accompanying diseases (pancreatitis, enterocolitis, hepatitis). • Mixed disturbances. • combination with dumping or postvagotomy diarrhea.

  19. Billroth I andBillroth IIresection

  20. Billroth II resection

  21. BILLROTH II RESECTION

  22. BILLROTH II RESECTION

  23. BILLROTH I RESECTION

  24. BILLROTH I RESECTION:

  25. Gastrectomy by B-II

  26. Distal resection of the stomach with saving of the perigastral vessels 1 3 2 4

  27. Aiming resection of the ischemic segment of stomach in combination with SPV(by L.J. Kovalchuk) 3 2 межі резекції перехідного сегмента шлунка; формування гастро-гастроанастомозу: задня і передня губа; остаточний вигляд сформованого гастро-гастроанастомозу. 1

  28. Proximal resection of the stomach межі резекції; завершений вигляд оперованого шлунка.

  29. Proximalsubtotalresection of the somach схема операції; перерізання шлунка; перерізання абдомінального відділу стравоходу.

  30. Gastrectomy(А – scheme; Б – end view) Esophago-jejunuanastomosis; Entero-entroanastomosis.

  31. Degrees of weight of the dumping syndrome

  32. Degrees of weight of the dumping syndrome

  33. Degrees of weight of the dumping syndrome

  34. Dumping syndrome(quickevacuationof the contrast)

  35. Depending on reasons and mechanisms of development of dumping syndrome there are different methods of the repeated reconstructive operations. All of them can be divided into four basic groups: • Operations which slow evacuation from stump of stomach. • Redoudenization. • Redoudenization with deceleration of evacuation from stump of stomach. • Operations on a thin bowel and its nerves.

  36. Basic stages of reconstructive operations • disconnection of adhesions in an abdominal cavity, releasing of gastrointestinal and interintestinal anastomosis and stump of duodenum; • cutting or resection of efferent and afferent loops; • renewal of continuity of upper part of digestive tract.

  37. Hypoglycemic syndromeThe attacks of weakness at a hypoglycemic syndrome arise up as a result of decline of content of sugar in a blood.

  38. Distinguished easy, middle and heavy degrees of afferent loop syndrome

  39. All operative methods of treatment of afferent loop syndrome can be divided into three groups: • Operations, that will liquidate the bends of afferent loop or shorten it. • Drainage operations. • Reconstructive operations.

  40. CLASSIFICATION I. By etiology: А. True duodenal ulcer. B. Symptomatic ulcers. II. By passing of disease: 1. Acute (first exposed ulcer). 2. Chronic: a) with the rare exacerbation; b) with the annual exacerbation; c) with the frequent exacerbation (2 times per a year and more frequent).

  41. CLASSIFICATION III. By the stages of disease: 1. Exacerbation. 2. Scarring: a) stage of “red” scar; b) stage of “white” scar. 3. Remission. IV. By localization: 1. Ulcers of bulb of duodenum. 2. Low postbulbar ulcers. 3. Combined ulcers of duodenum and stomach.

  42. CLASSIFICATION V. By sizes: 1. Small ulcers up to 0,5 cm. 2. Middle — up 1,5 cm. 3. Large — up to 3 cm; 4. Giant ulcers over 3 cm. VI. By the presence of complications: 1. Bleeding. 2. Perforation. 3. Penetration. 4. Organic stenosis. 5. Periduodenitis. 6. Malignization.

  43. CLINICAL MANAGEMENT • Pain • Vomiting • Heartburn • Belching

  44. DUODENOSCOPY

  45. STENOSIS SYMPTOM OF “Haudek's niche”

  46. DIAGNOSIS PROGRAM • 1. Anamnesis and physical examination. • 2. Endoscopy. • 3. X-Ray examination of stomach and duodenum. • 4. General and biochemical blood analysis. • 5. Coagulogram.

  47. METHODS OF SURGICAL TREATMENT • organ-saving operations; • organ-sparing operations; • resection.

  48. TRUNK VAGOTOMY (TrV) 2 4

  49. SELECTIVE VAGOTOMY (SV) 3

  50. SELECTIVE PROXIMAL VAGOTOMY (SPV)

More Related