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General Surgery
Benign Gastric Disorders
Built from Maingot's Abdominal Operations
What’s inside
15 sections · 183 slides
Overview
- Scope of benign gastric disorders
- Shift from elective to emergency ulcer surgery
Helicobacter pylori infection
The bacterium that turned ulcer disease into an infection
- Helicobacter pylori as a cause of ulcer disease
- Global prevalence of Helicobacter pylori infection
- Reservoir and transmission of Helicobacter pylori
- Survival of Helicobacter pylori in gastric acid
- Bacterial urease and acid buffering
- Host response to Helicobacter pylori
- Evidence linking Helicobacter pylori to duodenal ulcer
- Gastric metaplasia and duodenal colonisation
- Treatment evidence supporting the infectious origin
- Infection without ulceration
- Noninvasive tests for Helicobacter pylori
- Stool antigen and serological testing
- Endoscopic biopsy diagnosis of Helicobacter pylori
- Culture and antibiotic sensitivity testing
- Principles of eradication therapy
- First-choice treatment for Helicobacter pylori infection
- Antibiotic resistance and rescue therapy
- Second-line levofloxacin-based regimen
Nonulcerative dyspepsia
Upper abdominal pain with nothing to find
- Definition and burden of dyspepsia
- Features of nonulcerative dyspepsia
- Eradication therapy and surgical relevance
Peptic ulcer disease
Cause, risk factors and diagnosis
- Epidemiology of peptic ulcer disease
- 21%
- Determinants of mortality in peptic ulcer disease
- Two main causes of peptic ulceration
- Balance of acid and mucosal defence
- Cigarette smoking as a risk factor
- Smoking as a dependent rather than independent risk
- Gastric acid secretion in peptic ulceration
- Mucosal defence and cytoprotective agents
- NSAIDs and gastroduodenal injury
- Mechanism of NSAID mucosal injury
- Risk of ulceration on long-term NSAID use
- Clinical features of duodenal ulcer
- Differential diagnosis of epigastric pain
- Endoscopy versus contrast radiography
- Limitations and risks of endoscopy
- Endoscopic appearance of peptic ulcers
- Sites of peptic ulceration
- Biopsy policy at endoscopy for duodenal ulcer
Operative treatment of ulcer disease
Procedures, physiology and side effects
- Contemporary indications for peptic ulcer surgery
- Goals of contemporary ulcer surgery
- Combining endoscopic, radiologic and operative therapy
- Declining use of vagotomy and gastrectomy
- Truncal vagotomy
- Drainage procedures after truncal vagotomy
- Heineke-Mikulicz pyloroplasty
- Heineke-Mikulicz pyloroplasty: incision and opening
- Heineke-Mikulicz pyloroplasty: transverse closure
- Finney pyloroplasty
- Finney pyloroplasty: exposure and anterior suture line
- Finney pyloroplasty: posterior and seromuscular layers
- Jaboulay gastroduodenostomy
- Jaboulay gastroduodenostomy: planned incisions
- Jaboulay gastroduodenostomy: completed anastomosis
- Truncal vagotomy with antrectomy
- Reconstruction after antrectomy
- Proximal gastric vagotomy
- Technique of proximal gastric vagotomy
- <0.05%
- Caveat on reported mortality figures
- Acid secretion after vagotomy
- Acid output after adding antrectomy
- Gastrin levels after vagotomy and antrectomy
- Gastric emptying after vagotomy
- Emptying of solids after the two vagotomies
- Dumping after ulcer operations
- Diarrhoea after vagotomy
- Ulcer recurrence after operation
- Effect of ulcer site on recurrence after selective vagotomy
Ulcer haemorrhage
The commonest and the deadliest ulcer complication
- Burden of bleeding from peptic ulcer
- Risk factors for death from bleeding ulcer
- Endoscopy in suspected ulcer bleeding
- Stigmata of active and recent haemorrhage
- Ulcer stigmata and rebleeding in peptic ulcers
- Clinical predictors of recurrent bleeding
- Continuous proton pump inhibitor infusion
- Methods of endoscopic haemostasis
- Failure rates for endoscopic hemostasis
- Indications for endoscopic therapy
- Ulcers that need no endoscopic treatment
- Repeat endoscopic treatment after early rebleeding
- Benefits of early endoscopy
- Indications for operation in bleeding ulcer
- Emergency operation for bleeding ulcer
- Rebleeding rates by procedure for bleeding peptic ulcer
- Eradication therapy after ulcer bleeding
- Eradication of H. pylori and ulcer rebleeding
- Stepwise management of the bleeding peptic ulcer
Perforation
A hole in the duodenum and the peritonitis it causes
- Presentation of perforated duodenal ulcer
- Examination and imaging in perforation
- Operative management of perforation
- Recurrence after simple closure alone
- Rationale for omental patch with eradication therapy
- Mortality determinants in perforated ulcer
- Decline of acid-reducing operations for perforation
Gastric outlet obstruction
When the stomach cannot empty
- Acute gastric outlet obstruction
- Hypochloraemic alkalosis in pyloric obstruction
- Chronic pyloric stenosis
- Balloon dilation and definitive operation
- Operations used for chronic obstruction
Gastric ulcer disease
Different from duodenal ulcer, and always biopsied
- Epidemiology of benign gastric ulcer
- Endoscopic appearance and biopsy of gastric ulcer
- Location of benign gastric ulcers
- Causes of benign gastric ulcer
- Other associations of gastric ulceration
- Medical therapy for benign gastric ulcer
- Elective operation for benign gastric ulcer
- Points of transection for distal gastrectomy
- Vagotomy and emergency resection in gastric ulcer
- Type IV juxtaesophageal gastric ulcer
- Intractability and nonhealing peptic ulcer
- Differential diagnosis of intractability or nonhealing peptic ulcer
- Selecting patients for operation in nonhealing ulcer
- Choice of operation in intractable ulcer
- Operations for gastric ulcer: excision, antrectomy, Pauchet
- Operations for high gastric ulcer
Postgastrectomy syndromes
Problems the operation itself creates
- Frequency of postgastrectomy syndromes
- Early and late dumping
- Mechanism and course of dumping
- Treatment of dumping
- Mechanisms of action of octreotide in dumping syndrome
- Presentation of alkaline reflux gastritis
- Differential diagnosis of postoperative epigastric pain
- Endoscopic and histologic findings in bile reflux
- Treatment of alkaline reflux gastritis
- Roux-en-Y gastrojejunostomy for alkaline reflux gastritis
- Results of Roux-en-Y diversion
Stress ulcer disease
Gastric erosions in the critically ill
- Stress gastritis in critical illness
- 0.4%
- Injuries that predispose to stress gastritis
- Risk factors for stress ulcer bleeding
- Coagulopathy and mechanical ventilation as risks
- Who is not at increased risk
- Endoscopic and histologic findings in stress ulceration
- Healing and prophylaxis practice
- True incidence and other causes of postoperative bleeding
Upper gastrointestinal bleeding
The wider problem in which ulcer bleeding sits
- Incidence and mortality of upper gastrointestinal bleeding
- Role and timing of endoscopy
- What early endoscopy does and does not achieve
- Causes of acute upper gastrointestinal haemorrhage
- Initial treatment and drug therapy
- Limits of acid suppression in acute bleeding
- Endoscopic haemostasis and the action of adrenaline
- Complications of endoscopic therapy
- Repeat endoscopy versus emergency surgery
- Endoscopic treatment of variceal bleeding
- Eradication after ulcer-related upper GI bleeding
Other benign gastric conditions
Polyps, bezoars, vascular lesions and motility problems
- Types of gastric epithelial polyp
- Malignant potential of gastric polyps
- Management of gastric polyps
- Gastric lipoma
- Bezoars
- Presentation and treatment of bezoars
- Dieulafoy's lesion
- Diagnosis and treatment of Dieulafoy's lesion
- Gastric diverticula
- Ingested foreign bodies
- Mallory-Weiss tear
- Treatment of continued bleeding from a mucosal tear
- Gastric volvulus
- Management of gastric volvulus
- Operation for gastric volvulus
- Gastroparesis
- Diagnosis and surgical options in gastroparesis
Laparoscopic gastric operations
Which of these operations suit keyhole surgery
- Scope of laparoscopic gastric surgery
- Laparoscopic wedge resection of benign lesions
- Port placement and benefits of the laparoscopic approach
Summary
What to carry away from benign gastric disorders
- Core principles of benign gastric disease
- Operative principles to remember
- Complications and other conditions to remember
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- Maingot's Abdominal Operations, 12th Edition