ANATOMY The stomach is divided into the fundus, body, and antrum Hydrochloric acid—secreting parietal cells are found in the ...
ANATOMY
- The stomach is divided into the fundus, body, and antrum
- Hydrochloric acid—secreting parietal cells are found in the fundus,
- Pepsinogen-secreting chief cells are found in the proximal stomach
- Gastrin-secreting G cells are found in the antrum.
The duodenum is divided into four Parts
- 1st portion :begins at the pylorus and includes the duodenal bulb
- 2nd portion :location of ampulla of Vater
- 3rd portion :traversed anteriorly by the superior mesenteric vessels
- 4th portion :terminates at the ligament of Treitz(duodenal–jejunal junction)
The arterial supply to the duodenum
- superior pancreaticoduodenal (<—gastroduodenal artery)
- inferior pancreaticoduodenal artery (<--superior mesenteric artery)
GASTRIC AND DUODENAL ULCERATION
Etiology
- NSAD (alter prostaglandin synthesis)
- alcohol, and tobacco (restricts mucosal vascular )
- Helicobacter pylori
HISTORY
- epigastric pain relieved by antacids
- Sensations of fullness and mild nausea
- vomiting is rare (unless scarring-->pyloric obstruction)
- occasional epigastric tenderness.
Investigation
- barium studies (crater deformities)
- Serum testing :antibodies to H. pylori
- breath testing confirms infection.
- Definitive diagnosis : endoscopy
- biopsy : rule out gastric carcinoma
TREATMENT
Medical treatment
- Medications include
- antacids (CaCO3),
- H2-blockers (cimetidine, ranitidine),
- mucosal coating agents (sucralfate), and
- proton-pump inhibitors (omeprazole).
If H. pylori is present,
- tetracycline/metronidazole/bismuth-subsalicylate, or
- amoxicillin/metronidazole/ranitidine , or other combinations.
Surgical treatment
- reduce acid secretion by removing the entire antrum.
- vagotomy and distal gastrectomy (antrectomy), with Billroth I or II anastomosis,
- perforation are treated with closure of the defect with omental patch
