Classic indications and goals for peptic ulcer surgery Since the introduction of H 2 -receptor antagonists and proton pump inhibitors (PPIs) and the identification of Helicobacter pylori as an ulcerogenic cofactor, the frequency of elective operations for peptic ulcer disease (PUD) has decreased by more than 90%. Currently, surgery for duodenal and gastric ulcers is reserved for the management …
Types of gastric ulcers There are Five types of gastric ulcers in terms of location, gastric acid secretory status, incidence, and complications. Peptic ulcers are a common cause of upper gastrointestinal (GI) symptoms with peak incidence in middle-aged men (55-65). They arise at various locations, including the stomach (gastric ulcer), duodenum (duodenal ulcer), and esophagus …
What are some other nonsurgical causes of acute abdomen? The list of medical causes of acute abdominal pain is long and can often cause diagnostic dilemmas if the index of suspicion is low. It includes diabetic ketoacidosis, hypercalcemia, myocardial infarction, pneumonia, ureteral calculi, and gastroenteritis. Careful history, repeat examinations, and judicious use of diagnostic imaging …
How is colonic perforation after colonoscopy treated? The risk of perforation of the colon is 0.19% to 0.4% after diagnostic colonoscopy and 0.3% to 1% with polypectomy. In a well-prepped colon, bowel rest, antibiotics, and observation are often appropriate, provided there is no evidence of diffuse peritonitis. For small perforations, early (within 24 hours) laparoscopic …
How is colonic perforation after colonoscopy treated Read More »
How to manage abdominal and back pain after ERCP Acute post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a feared and potentially fatal complication that can be as high as up to 30% in high-risk patients. Most patients with PEP have an acute onset of severe and persistent epigastric abdominal pain and in approximately 50% of patients, …
How to manage abdominal and back pain after ERCP Read More »
How should toxic megacolon in the setting of ulcerative colitis be managed? Aggressive fluid resuscitation, bowel rest, broad-spectrum antibiotics, and intravenous corticosteroids are the mainstays of medical therapy. Serial abdominal examinations and plain films are mandatory to assess for colonic distention or impending perforation. Total abdominal colectomy with end-ileostomy is often required if there is …
How should toxic megacolon in the setting of ulcerative colitis be managed Read More »
Should older adult patients with sigmoid or cecal volvulus undergo surgery? Yes. After immediate reduction with barium enema or endoscopy, the recurrence rate may be as high as 50% to 90%. Unless the patient cannot tolerate an operation or is in a moribund state, surgery should be offered during the same hospitalization.