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Peptic Ulcer -Investigations
• Endoscopy
• Tests for H.pylori13C and 14C breath tests
CLO testHistpathology
Serology
Peptic Ulcer -Treatment
• Medical treatment (H2-receptor antagonists / PPI)
• Eradication treatment (PPI + Metronidazole + Amoxycillin /
clarothromycin)
• Surgery
• Long history of Long history of peptic ulcer peptic ulcer
diseasedisease• VomitingVomiting• Weight lossWeight loss• Dehydration Dehydration
• Succussion splashSuccussion splash• PeristalsisPeristalsis• TetanyTetany
Investigations
Laboratory Laboratory investigationsinvestigations
Hypochloraemic alkalosis; Hypochloraemic alkalosis;
hyponatremia; hyponatremia;
hypokalaemiahypokalaemia
Investigations
Saline load test• 700 ml normal saline infused over 3-4
minutes
• Tube clamped for 30 minutes
• Stomach aspirated
•Recovery of >350 ml indicates obstruction
Treatment
•Correction of fluid & electrolyte imbalance
Rehydration with isotonic saline and potassium supplements
Treatment
• Medical treatmentGastric lavage and suction (5-7 days)
• Surgical treatmentTruncal vagotomy with gastrojejunostomy
• Endoscopic treatmentBalloon dilatation
… in summary
• Most commonly associated with PUD and carcinoma stomach
• Hypochloraemic alkalosis & paradoxical aciduria
• Medical / endoscopic dilatation effective in less severe cases
• Operation with a drainage procedure usually required
Most perforated ulcers are Most perforated ulcers are located anteriorlylocated anteriorlyabsence of protective viscera | major absence of protective viscera | major blood vesselsblood vessels
Pain•PainPain
•DistressedDistressed•Shallow breath Shallow breath
•RigidityRigidity•Absent gut Absent gut
soundssounds•Tympanitic Tympanitic
note over livernote over liver
Investigations
Laboratory investigationsLeucocytosis ; raised serum amylase
High levels of amylase in aspirated fluid
ImagingGas under diaphragm
Escape of contrast material from the lumen
Endoscopic Treatment -Indications
Active bleeding at the time of endoscopy
Visible vessel at the base of the ulcer
Emergency Surgery
Hypotensionon admission
4 units of bloodto achieve circulatory stability
Continuous bleeding Subsequent transfusion requirements
exceed 1 unit every 8 hours
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