Complication of peptic ulcer disease.pptx

Complications of Peptic Ulcer disease- Perforation, bleeding, stenosis

1. COMPLICATIONS OF PEPTIC ULCER

2. Commonest complications of peptic ulcers Perforation (anterior wall ulcer) Bleeding (posterior wall ulcer) Stenosis

3. PERFORATED PEPTIC ULCER Incidence has reduced due to widespread use of medicines Becoming more common in elderly NSAIDS appear to be responsible for most of these perforations

4. PERFORATED PEPTIC ULCER Clinical Features Sudden onset of severe generalised abdominal pain. May be more prominent in epigastrium and right iliac fossa Deterioration in patients condition due to impending shock( tachycardia, tachypnoea, temperature +/- Board like rigidity of abdomen/Rebound tenderness Abdomen doesn’t move with respiration

5. PERFORATED PEPTIC ULCER Investigation Chest Xray in erect posture - Gas under diaphragm CT is also helpful Serum Amylase to exclude Pancreatitis (slightly elevated Amylase may be seen in perforated peptic ulcer or Acute abdomen but not as high as in Pancreatitis General investigation like CBC, LFT, KFT, Serum electrolytes and ultrasound are supportive

6. PERFORATED PEPTIC ULCER Treatment Proper resuscitation with I/V line, Catheterisation, Naso - gastric suction and Analgesia If the symptoms are mild and patient is stable with good vital parameters—Try to evaluate if the perforation is sealed, which can be managed conservatively Otherwise, surgery is the treatment of choice H. Pylori eradication is mandatory Causes of Peptic ulceration should have to be removed completely Lifelong treatment with PPIs may be necessary

7. BLEEDING Causes of Upper GI bleed - Ulcers 60% (Oesophageal 6, Gastric 21, Duodenal 33) Erosions 26% (Oesophageal 13, Gastric 9, Duodenal 4) Mallory Weiss tear 4% Oesophageal varices 4% Tumour .5% Vascular lesions .5% Others 5%

8. BLEEDING Clinical presentation- Patient presents with Haematemesis ( Coffee coloured or brown coloured blood ) in acute cases or Melaena (Black stools) in chronic cases.

9. BLEEDING Initial assessment and management- Whatever the cause---principles of management are the same- Adequate resuscitation- I/V fluids, Blood transfusions, wide bore Naso - gastric tube to suck out the blood and lavage by ice cold water. Quick history- of Chronic alcoholism, Chronic smoker, any anticoagulant therapy or blood thinners, recent intake of NSAIDS

10. BLEEDING 3. Most of the Upper GI bleed stops temporarily – Diagnostic endoscopy and simultaneous haemostasis is achieved in 70% of cases by Adrenaline injection and/or sclerosing agent/clips 4. If large vessel is bleeding or a rebleed occurs after endoscopy, Angiographic transcatheter embolization may be helpful in expert centres otherwise proceed for urgent surgery.

11. BLEEDING Surgery is indicated If rebleed occurs after endoscopy If a large vessel is bleeding at the base of Peptic ulcer If more than 6 units of Blood have already been transfused Early surgery may be required in frail and elderly patients. If bleeding continues or the facility of embolization is not available. Once the bleeding is stopped- definitive management of the underlying cause should be started to prevent rebleed.

12. STENOSIS Cause of stenosis is healing by Fibrosis and scaring, leading to the narrowing of the lumen and if untreated, leading to complete pyloric obstruction.

13. STENOSIS Clinical features Usually, a long history of Peptic ulcer disease is found along with smoking habit. Recurrent vomiting containing undigested food even after 24 hrs, having no bile in it. Dehydration Weight loss Distended stomach may be visible with a typical succussion splash.

14. STENOSIS Management Treating the underlying hypochloraemic Alkalosis (persistent vomiting of HCL from stomach leads to Chloride deficiency) and electrolyte imbalance. Normal Saline infusion with Potassium supplementation to correct dehydration and acid base imbalance. Wide bore Naso - gastric tube should be inserted to suck out all the gastric contents. Now Endoscopy should be performed and Biopsy should be obtained to rule out malignancy. Endoscopic balloon dilatation may be helpful in early cases. Surgery is the treatment of choice in severe /complete stenosis.

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