Benign Gastric Ulcers - DNicastri

Benign Gastric Ulcers - DNicastri - Benign Gastric Ulcers...

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Benign Gastric Ulcers Daniel G. Nicastri, M.D. January 24 th , 2007
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E.R. 89F w/dementia, Parkinson’s disease, hypertension, and history of recent NSAID use for arthritis Presented to ER with melena, dropping Hgb to 6.6 from baseline 10 Put on PPI’s, stabilized, and transfused Underwent elective EGD revealing multiple ulcers
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E.R. 5 Ulcers Body: 3 total, ~1cm with adherent clot (deep), and second ~3cm, third not described in size Antrum/Angularis: ~4cm, not bleeding, borders biopsied Another deep ulcer injected with epinephrine, “concerning for penetrating ulcer” along greater curvature Gastritis CXR/ABD film done because of distention and deep ulcer
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OR NGT/IVF/Antibiotics Exploratory laparotomy Oversewn gastric perforation with omental patch Transferred stable to SICU Unremarkable recovery on PPI’s
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Benign Gastric Ulcers Until late 1970’s treatment was primarily surgical Mortality for emergency surgery high (16% at Ohio State University) Medical therapy has reduced number of elective operations Despite this 3000 U.S. deaths/year due to gastric ulcers 10% of all gastric ulcers harbor malignancy
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Surgical Indication and Associated Mortality (Ohio State University 1968-1972) Indication No. (%) Mortality Intractability 583(85%) 13% Hemorrhage 86 (12%) 31% Perforation 17 (2%) 53% Obstruction 9 (1%) 0% TOTAL 695 16%
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Ulcer Pathogenesis Decreased mucosal protection NSAID’s Steroids Hypersecretion of acid H.pylori (75% of gastric ulcers caused by this) Smoking and EtOH correlation Gastrin (Zollinger-Ellison)
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Treatment Primarily medical PPI or H2 blocker Triple combination (double antibiotic and PPI=amoxicillin, clarithromycin, pantoprazole for 7-14 days) Surgical indications Intractibility (after medical therapy) Hemorrhage Obstruction Perforation Relative: continuous requirement of steroid therapy/NSAIDs
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This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Benign Gastric Ulcers - DNicastri - Benign Gastric Ulcers...

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