gastrodeudenal can

Gastroduodenal ulcer
——Massive hemorrhage of ulcer
We could kown pathological changes and bleeding position though barium meal examination, endoscope or DSA. Massive hemorrhage of ulcer must be distinguished from other causes of hemorrhage of upper gastrointestinal tract for massive hemorrhage, for example: portal hypertension, acute hematobilia, bleeding of gastric cancer.
Gastroduodenal ulcer
——Acute perforation of ulcer
operative treatment: all perforative patients who don't fit to non-operative treatment or is ineffective by non-operative treatment, need operative treatment timely. There are two methods:
In therapy, patients have complications (for pyloric obstruction . perforation or massive
hemorrhage) occur.
perforating ulcer.
——Acute perforation of ulcer
Gastroduodenal ulcer
——preface
Most of peptic ulcer occur at gastric and duodenum (more than 95％),is also called gastricoduodenal ulcer. The patients of gastric ulcer are elder than those of duodenal ulcer. Gastric ulcer is first recorded in 1586,and
perfr
——Acute perforation of ulcer
Acute perforation of ulcer, according to illness, can chose non-operative treatment or operative treatment. non-operative treatment indications: pure and small perforation, leak out little, well general conditions, peritonitis localized when see doctor, no server infection and shock.
singlet suture of perforation-advantages: simple,
little time and less risk.
Gastroduodenal ulcer
——Acute perforation of ulcer
Subtotal gastrectomy-advantages: it not only resolved perforation but also cure the ulcer.
Gastroduodenal ulcer
——Massive hemorrhage of ulcer
Most patients don not have ulcer history before bleeding, about 10~15% Massive hemorrhage patients don not have ulcer complicaions. All massive hemorrhage patients show these signs: 1.spitting blood and coaltar-like shit; 2.shock; 3.anemia; 4.other complications.
duodenal ulcer is in 1688.
Gastroduodenal ulcer
——nosogenesis
Most of patients of gastric ulcer are accompany with acid cells cut and acid drop. It is generally consider that gastric ulcer is caused by lessened protection feature of mucosa and mucosal barrier (slime flux, secretion of alkali solution. Synthesis
Gastroduodenal ulcer
Acute perforation is one of the severe complications of ulcer, it occupy 10~15% of all ulcer patients, most of them are duodenal ulcer, it is 15 times more than gastric ulcer, acute perforation attack sharply, vary quickly, if not be cured timely, patients may be died of peritonitis.
——Acute perforation of ulcer
Gastroduodenal ulcer
Free gas in abdominal cavity -after perforation, gas enter into abdominal cavity from stomach and duodeum, 75% of patients could be found that hepatic dullness reduce or disappear.
rate of prostaglandin of intramucosal).
Gastroduodenal ulcer
——nosogenesis
Acid and pepsin are main factors effect to duodenal ulcer. "No acid no ulcer" is accepted now although it was raised a hundred years ago, About 1/3～1/2 of duodenal ulcer patients have a high acid secretion .It is generally agreed that chronic duodenal ulcer is caused by high secretion of acid and pepsinogen, which hurt mucosa.
It is usually agreed that if the general condition is well, have pyloric obstruction or bleeding before, perforating in 12 hours, slight pollution in abdominal cavity, can do Subtotal gastrectomy, otherwise do singlet suture.
20% of gastric ulcer.
Gastroduodenal ulcer
——operation indication
After therapy, ulcer recurrence, especially in 6~12 months, is considered as ulcerogenic.
——Acute perforation of ulcer
Follows are main symptoms and signs:
Gastroduodenal ulcer
abdominal pain -the prime modal and most important symptom is badly and gusty abdominal pain. abdominal tenderness -it may be localized to the upper abdomen and right of it . abdominal muscle tension -when peritoneum irritated, abdominal muscle tension sharply, is often called board-like rigidity.

X-ray check -do X-ray stand ,about of 80%~90% could find lunule free gas under diaphragm, it is
very helpful for diagnosis.

Other symptoms-fever, pulse quick.WBC increase and so on, show up after several hours of
Gastroduodenal ulcer
——operation indication
Disunion of ulcer for long time, especially massive ulcer (D>2.5cm), though no found cancer cells in biopsy,is need surgical operation. . After 12 weeks~15 weeks of medical therapy, the ulcer can not union ,for multiple ulcer , occupy