MindMap Gallery Surgical treatment of gastroduodenal ulcer
The ninth edition of the textbook "Surgery", Surgical Treatment of Gastroduodenal Ulcer, summarizes the pathogenesis, clinical manifestations, diagnosis, differential diagnosis, Surgical treatment, etc.
Edited at 2024-04-05 19:39:29Ce calendrier annuel, créé avec EdrawMax, présente une disposition claire et organisée des mois de janvier à décembre. Chaque mois est affiché dans un cadre distinct, montrant les jours de la semaine et les dates correspondantes. Les weekends (samedis et dimanches) sont mis en évidence pour une meilleure visibilité. Ce format est idéal pour la planification et l'organisation des activités tout au long de l'année, offrant une vue d'ensemble rapide et facile à consulter.
This quarterly calendar overview for 2026, created with EdrawMax, presents a structured and colorful layout of the entire year divided into four quarters. Each quarter is displayed in a separate column, showcasing the months within that quarter in a clear grid format. The days of the week are labeled, and each date is marked within its respective cell, allowing for easy identification of dates across the year. This calendar is an excellent tool for long-term planning, providing a comprehensive view of the year at a glance.
This weekly calendar for 2026 is designed using EdrawMax to provide a detailed and organized view of each week, starting from January. The left side features a mini monthly calendar for quick reference, highlighting the current week in yellow. Below it, there's a section for weekly goals to help prioritize tasks. The main area is a time-grid from 6:00 AM to 12:00 AM, divided into half-hour slots, allowing for precise scheduling of daily activities throughout the week. This layout is ideal for managing a busy schedule efficiently.
Ce calendrier annuel, créé avec EdrawMax, présente une disposition claire et organisée des mois de janvier à décembre. Chaque mois est affiché dans un cadre distinct, montrant les jours de la semaine et les dates correspondantes. Les weekends (samedis et dimanches) sont mis en évidence pour une meilleure visibilité. Ce format est idéal pour la planification et l'organisation des activités tout au long de l'année, offrant une vue d'ensemble rapide et facile à consulter.
This quarterly calendar overview for 2026, created with EdrawMax, presents a structured and colorful layout of the entire year divided into four quarters. Each quarter is displayed in a separate column, showcasing the months within that quarter in a clear grid format. The days of the week are labeled, and each date is marked within its respective cell, allowing for easy identification of dates across the year. This calendar is an excellent tool for long-term planning, providing a comprehensive view of the year at a glance.
This weekly calendar for 2026 is designed using EdrawMax to provide a detailed and organized view of each week, starting from January. The left side features a mini monthly calendar for quick reference, highlighting the current week in yellow. Below it, there's a section for weekly goals to help prioritize tasks. The main area is a time-grid from 6:00 AM to 12:00 AM, divided into half-hour slots, allowing for precise scheduling of daily activities throughout the week. This layout is ideal for managing a busy schedule efficiently.
Surgical treatment of gastroduodenal ulcer (ulcer itself)
1.
Seen under gastroscopy
Types
2. Surgical methods and mechanisms
subtotal gastrectomy
Selective vagotomy + pyloroplasty
3. Early postoperative complications
1. postoperative gastric bleeding
Clinical features
Bleeding within 24 hours (>300ml):
Improper hemostasis;
Bleeding after 4-6 days:
Anastomotic mucosal necrosis;
Bleeding within 10-20 days:
Infection at the anastomotic suture
Processing principles
Non-surgical treatment → gastroscopic hemostasis, selective celiac artery embolization → surgical hemostasis
2. Postoperative gastroparesis
Clinical features
Persistent epigastric fullness and vomiting (food bile);
The remnant stomach is dilated and has less peristalsis in superior contrast angiography
Processing principles
Fasting of water, continuous gastrointestinal decompression, and promotion of gastric motility (erythromycin);
improvement sign
Gastric juice in the gastric tube turns from green to yellow or clear
3. ischemic necrosis of gastric wall
Clinical features
More common in highly selective vagotomy, gastric lesser curvature mucosal necrosis, ulcers >3cm causing bleeding
Processing principles
Intraoperative seromuscular suturing
4. Anastomotic rupture or fistula
One week after surgery, if diffuse peritonitis occurs
Conservative; surgical repair and adequate drainage
5. Duodenal stump rupture
Clinical features
After type II surgery, severe pain in the upper abdomen, fever, peritoneal irritation in the upper abdomen, and bile-like fluid on abdominal puncture
Processing principles
Immediate surgery (duodenostomy, side-to-side anastomosis of input-output loops)
6. postoperative obstruction
1. input loop
Acute obstruction:
Clinical features
It usually occurs in Bi II type precolonic input loop surgery on the lesser curvature of the stomach; severe pain in the upper abdomen and vomiting (small amount, no bile)
Processing principles
It is a closed loop obstruction and requires surgical treatment.
chronic obstruction
clinical manifestations
Upper abdominal cramping and vomiting half an hour after the meal (large amount, large amounts of bile, abdominal pain relieved after vomiting)
Processing principles
Fasting, gastrointestinal decompression → surgery (input loop-output loop side-to-side anastomosis)
2. Output loop
Clinical features
It usually occurs in Bi type II retrocolonic anastomosis or postoperative intestinal adhesion, upper abdominal fullness, vomiting (bile gastric contents)
Processing principles
Operation
3. anastomosis
Clinical features
It is more common in anastomotic stoma that is too small and anastomotic edema, which is the same as output loop obstruction.
Processing principles
Can be relieved with conservative treatment
4. late postoperative complications
1. alkaline reflux gastritis
Clinical features
Months to years after BiII surgery, alkaline bile, pancreatic juice, and intestinal juice reflux, burning pain in the upper abdomen or retrosternal region, and vomiting
Processing principles
Gastric mucosal protective agent, gastric motility promoter, cholestyramine
2. dumping syndrome
Early dumping syndrome (hypovolemic):
Clinical features
Within half an hour after a meal, palpitations, sweating, pale complexion, and diarrhea
Processing principles
Diet modification therapy (smaller meals more frequently), somatostatin
Late dumping syndrome (hypoglycemic):
Clinical features
2-4 hours after meal, cold sweat and weak pulse
Processing principles
Diet modification therapy (smaller meals more frequently), somatostatin, pectin addition to food
3. ulcer recurrence
Clinical features
Abdominal pain, ulcer bleeding
Processing principles
Acid-suppressing Anti-HP
4. nutritional complications
Clinical features
weight loss, anemia (iron and vitamin B12 deficiency)
Processing principles
Supplement iron, vitamins and calcium
5. Diarrhea after vagotomy
Clinical features
diarrhea
Processing principles
Peramide (Imodium)
6. remnant stomach cancer
Clinical features
Primary cancer in the residual stomach more than 5 years after gastroduodenal patients underwent subtotal gastrectomy
Processing principles
Surgical treatment
7.
Clinical features
Processing principles
Surgical treatment of gastroduodenal ulcer (ulcer perforation)
Etiology and pathology
Predisposed areas
Anterior wall of duodenal bulb, lesser curvature of stomach
pathogenic bacteria
Escherichia coli
clinical manifestations
Sudden onset of severe knife-like pain in the upper abdomen, which quickly spreads to the entire abdomen; digestive juices flow downward along the ascending colon, causing "metastatic right lower abdominal pain"; shock
Abdominal breathing weakens or disappears; tenderness, rebound tenderness, and abdominal muscle tension appear "rigid"; hepatic dullness shrinks or disappears
diagnosis
Previous history of ulcer Typical symptoms and signs
Differential diagnosis
Acute appendicitis:
The signs were limited to the right lower quadrant, and there was no free air on the X-ray;
Acute pancreatitis:
Elevated amylase
treat
non-surgical
Suitable for patients with fasting perforation and peritonitis with localized symptoms and mild symptoms;
Operation
Simple perforation suturing (laparoscopic or open) Biopsy: suitable for cases with perforation lasting more than 8 hours without complications of bleeding or obstruction, especially duodenal ulcer
Radical ulcer surgery:
Suitable for subtotal gastrectomy within 8 hours, with ulcers and other complications
Surgical treatment of gastroduodenal ulcer (ulcer bleeding)
Etiology and pathology
Predisposed areas
The duodenum is the posterior wall of the bulb (bleeding from the gastroduodenal ulcer artery and superior pancreaticoduodenal artery); Gastric ulcers are located in the lesser curvature of the stomach (branches of the left and right gastric arteries)
Heavy bleeding
Bleeding volume exceeds 1ml per minute
clinical manifestations
1. Depending on the amount and speed of bleeding:
Vomiting blood and tarry stools, syncope, hemorrhagic shock
2. Hyperactive bowel sounds
Diagnosis and treatment
Emergency fiberoptic gastroscopy;
Selective celiac artery or superior mesenteric artery angiography
Upper gastrointestinal angiography is prohibited
treat
non-surgical
Blood transfusion, indwelling gastric tube (norepinephrine saline every 4-6 hours), acid suppression, somatostatin
Endoscopic treatment
Emergency gastroscopy (the patient needs to be hemodynamically stable), endoscopic hemostasis
Operation
Bleeding site through suturing
Surgical treatment of gastroduodenal ulcer (Cicatricial pyloric obstruction)
1. Pathogenesis
There are three mechanisms of pathogenesis of pyloric obstruction: spasm, inflammation, edema, scar, combined with hypokalemia and hypochloride alkalosis.
2. clinical manifestations
1. Recurrent episodes of vomiting, large volume (1000-2000ml), vomiting is rotten, sour food, does not contain bile
2. Weight loss, upper abdominal stomach pattern, gastric peristaltic waves, vibrating sound
3. diagnosis
1. upper gastrointestinal tract imaging
Gastric dilation and residual barium at 6 hours indicate gastric retention, and residual barium at 24 hours indicates cicatricial pyloric obstruction.
2. Salt water load test
An indwelling gastric tube was placed on an empty stomach and 700 ml of normal saline was injected. If more than 350 ml was recovered after 30 minutes, it indicated pyloric obstruction.
4. Differential diagnosis
1. Spastic or edematous pyloric obstruction;
2. Pancreatic head and periampullary cancer;
3. stomach cancer
5. Surgical treatment
1. Indications
cicatricial pyloric obstruction
2. Preoperative preparation
Fasting, gastrointestinal decompression, gastric lavage with hypertonic warm saline, correction of hypokalemic and hypochloremic alkalosis
3. technique
1. Mainly subtotal gastrectomy;
2. Vagotomy plus gastric antrum resection;
3. Gastrojejunostomy