Boli Chirurgicale - Ulcer

The correct answer is Oppel. Oppel's procedure involves using the omentum, a fold of the peritoneum, to cover and protect a perforated ulcer. This technique helps to prevent further leakage of gastric contents into the abdominal cavity and promotes healing of the ulcer. The omentum is mobilized and brought down to cover the perforation, providing a protective barrier and promoting the formation of granulation tissue. This procedure is commonly used in the surgical management of perforated gastric ulcers.

Adenomul ulcerogen produce cantităţi mari de gastrină. Gastrina este un hormon produs de celulele G din stomac și are rol în stimularea secreției de acid gastric. Adenomul ulcerogen este o tumoare care se dezvoltă la nivelul stomacului și poate duce la creșterea producției de gastrină. Această creștere a gastrinei poate duce la hipersecreția de acid gastric, ceea ce poate contribui la apariția ulcerului gastric.

The correct answer is "Dependentă de alimentaţie" which means "Dependent on diet" in English. This means that the pain in duodenal ulcer is influenced by the type of food consumed. Certain foods may aggravate the pain while others may provide relief.

The correct answer is "Prezenţa undelor peristaltice ale stomacului în stenoza pilorică ulceroasă" which translates to "The presence of peristaltic waves of the stomach in ulcerative pyloric stenosis." This answer suggests that the Kussmaul sign refers to the observation of normal or exaggerated stomach contractions in response to a blockage or narrowing of the pylorus, the opening between the stomach and the small intestine. This sign is commonly seen in cases of pyloric stenosis, a condition characterized by the narrowing of the pylorus due to ulcers.

The earliest sign of ulcer malignancy is the disappearance of the periodicity and intensity of pain. This suggests that the ulcer is no longer responding to treatment and may be progressing towards malignancy. Hematemesis and melena are signs of bleeding in the digestive tract, which can occur in advanced stages of ulcer malignancy. Weight loss can also occur as the disease progresses, but it is not the earliest sign.

In the case of a 45-year-old patient with a long history of refractory duodenal ulcer to medical therapy, the most appropriate surgery is a gastric resection of 2/3. This procedure involves removing two-thirds of the stomach, which can help alleviate the symptoms and complications associated with the refractory ulcer. By reducing the size of the stomach, the production of gastric acid is decreased, leading to a reduction in ulcer formation. This surgical option is considered when other treatments have failed to provide relief, making it the most suitable choice in this scenario.

The most characteristic laboratory sign for perforated ulcer is moderate leukocytosis (12,000-14,000) with increasing dynamics. This means that there is an increase in the number of white blood cells in the blood, indicating an inflammatory response to the perforation. The dynamic increase suggests that the condition is progressing and the body is trying to fight off the infection. This laboratory finding is specific to a perforated ulcer and helps in the diagnosis of the condition.

pH-metria is the most informative investigation of gastric secretion because it measures the acidity level in the stomach over a period of time. This test involves inserting a small tube through the nose or mouth into the stomach to monitor the pH levels. By measuring the pH, doctors can assess the amount and pattern of acid production in the stomach, which can help diagnose conditions such as gastroesophageal reflux disease (GERD) or evaluate the effectiveness of acid-reducing medications.

The most important sign of gastroduodenal anastomosis and suture line dehiscence is the elimination of methylene blue introduced into the stomach through abdominal drains. This suggests that there is a leakage or opening in the anastomosis or suture line, allowing the dye to escape into the abdominal cavity. This sign indicates a potential complication and requires immediate medical attention.

The correct answer is "Anastomoză gastroduodenală termino-terminală cu îngustarea tranşei de susţinere din partea curburii mici". This answer refers to the Pean-Billroth-I technique in gastric resection, which involves creating an anastomosis between the stomach and the duodenum. In this technique, the supporting part of the lesser curvature is narrowed to create a more secure connection.

Ulcerul se malignizează cel mai des în treimea distală a stomacului. This means that stomach ulcers are most likely to become malignant in the distal third of the stomach.

The given correct answer states that the symptoms described, such as intense abdominal pain, anxious appearance, dilated pupils, cold sweats, shallow breathing, Eleker's symptom, and forced antalgic position, correspond to the period after perforation. The answer indicates that these symptoms occur within the first 4-6 hours after the perforation occurs.

Ulcerul mediogastric conform clasificării Johnson este de Tipul I.

The correct answer is "În cele din tractul digestiv" and "În hemoragiilie din ulcerele acute". This means that conservative therapy is more frequently indicated in cases of postoperative hemorrhages that occur in the digestive tract and in cases of hemorrhages from acute ulcers.

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The correct answer is "Factorul de apărare" (Defense factor). In the etiopathogenesis of gastric ulcer, the defense factor plays a crucial role. This factor refers to the mechanisms and substances that protect the gastric mucosa from the damaging effects of gastric acid and other aggressive factors. These defense mechanisms include the secretion of mucus, bicarbonate, and prostaglandins, as well as the presence of a tight epithelial barrier. When the defense factor is compromised or inadequate, it can lead to the development of gastric ulcers.

The correct answer is "Ulcerele micii curburi cu antru şi pilor normale, având aciditate subnormală." This is because Johnson type I ulcers are characterized by small curvilinear ulcers located on the lesser curvature of the stomach, with normal antrum and pylorus and subnormal acidity.

The correct answer is "Tamponament cu sonda Blackmore + pituitrină i/v". This is the preferred method of hemostasis for bleeding grade III esophageal varices. The Blackmore probe is a specialized balloon catheter that can be inserted into the esophagus and inflated to apply pressure and stop the bleeding. Pituitrină is a medication that can be administered intravenously to further enhance vasoconstriction and promote hemostasis. This combination of tamponade and pharmacological intervention is effective in controlling bleeding from esophageal varices.

The correct answer is "Rezecţia stomacului cu anastomoză tip Billroth-I". This procedure involves the removal of a portion of the stomach and the attachment of the remaining stomach to the small intestine. It is known to have a lower risk of complications such as diarrhea compared to the other surgical interventions listed.

The correct answer is "Endoscopic" because the activity of upper gastrointestinal bleeding can be assessed and determined through an endoscopic examination. This procedure allows for direct visualization of the bleeding site and can help guide surgical intervention if necessary.

The correct answer is "Malignizarea." Malignizarea refers to the process of malignancy or the development of cancerous cells. In the context of Piloroplastia Heineke-Miculicz, it suggests that there is a risk of malignant transformation or the formation of cancer in the area being treated.

In the given answer, it is stated that the most important thing is to differentiate between ulcer bleeding and bleeding from ruptured esophageal varices. This is because the management and treatment approach for these two conditions are different. Additionally, it is mentioned that the source of the bleeding is located up to the duodeno-jejunal junction. This information is important for identifying the site of bleeding and determining the appropriate intervention.

The most common cause of mechanical evacuation disorders after gastric resection is anastomotic leakage. This refers to the leakage or breakdown of the surgical connection (anastomosis) between the stomach and the remaining portion of the digestive tract. This can lead to various complications, such as obstruction or narrowing of the passage, which can result in difficulty or inability to evacuate food or waste properly.

Anastomozita mai frecvent apare în perioada postoperatorie precoce după rezecţia gastrică Billroth-I, având ca cauză factorul microbian, trauma ţesuturilor, materialul de suturare (catgutul), procesul alergic etc. Semnele majore - dureri epigastrice şi vărsături abundente apar în zilele 7-10 zi.

The correct answer is "Rezecţia primară a stomacului" which means primary resection of the stomach. This is the indicated maneuver in gastric ulcer perforation if no more than 6 hours have passed since the perforation. This procedure involves removing the affected part of the stomach and reconnecting the remaining healthy portions. It is performed to treat the perforation and prevent further complications such as infection or bleeding.

Primary resection is not indicated in the case of duodenal ulcer perforation in patients over 60 years old, in association with hemorrhage, or in cases of suspected malignancy. However, it is also not indicated in cases of "mute" duodenal ulcers without a history of symptoms, and in young patients under the age of 30.

The given answer is correct because it states that the types of stenosis mentioned in the options include all except stenosis of the cardia and stenosis of the fundus. This implies that stenosis of the cardia and stenosis of the fundus are not considered as types of stenosis based on the location of the ulcerative process.

Adenomul ulcerogen (gastrinomul) is a form of a cystic or lobed nodule with varying consistency that, in 50% of cases, becomes malignant, metastasizes, and can be located in the pancreas, duodenum, gallbladder, and stomach.

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The most common gastric drainage operation associated with truncal vagotomy in emergency surgery for peptic ulcer disease is Piloroplastia Judd.

The correct answer is Perforaţia and Hemoragia. Acute complications of ulcerative disease can include perforation, which is when the ulcer creates a hole in the wall of the stomach or intestines, and hemoragia, which refers to bleeding from the ulcer. These complications can be serious and require immediate medical attention. Stenoza, malignizarea, and penetraţia are not specifically mentioned as acute complications of ulcerative disease.

The cephalic phase of gastric secretion is stimulated by factors such as the sight, smell, and touch of food, as well as chewing and salivation, swallowing, and the release of insulin. These factors activate the parasympathetic nervous system, leading to an increase in gastric secretions.

Ulcerul duodenal este o afecțiune în care se formează leziuni ulcerative în mucoasa duodenului. Complicațiile asociate cu ulcerul duodenal includ stenoza, hemoragia, penetrația și perforația. Stenoza se referă la îngustarea lumenului duodenal, ceea ce poate duce la dificultăți în trecerea alimentelor. Hemoragia poate apărea atunci când ulcerul sângerează, ceea ce poate duce la anemie sau chiar șoc hemoragic. Penetrația se referă la perforarea ulcerului în țesuturile adiacente, cum ar fi pancreasul sau cavitatea abdominală. Perforația este o complicație gravă în care ulcerul penetrează complet peretele duodenului, ceea ce poate duce la peritonită și necesită intervenție chirurgicală de urgență.

Biopsia ulcerului perforat este obligatorie în cazul ulcerului gastric acut, ulcerului gastric la un pacient trecut de 40 ani și ulcerului gastric Johnson II cu perforație în stomac. Aceste condiții necesită o evaluare mai detaliată a ulcerului pentru a exclude posibilitatea unui cancer gastric sau a altor afecțiuni grave. Ulcerul duodenal calos cu un diametru mai mare de 2 cm și ulcerul duodenal calos penetrant în pancreas și asociat cu hemoragie nu sunt menționate ca situații în care biopsia ulcerului perforat este obligatorie.

The correct answer includes acute pancreatitis, acute appendicitis, right-sided pleuropneumonia, and ruptured ectopic pregnancy as possible differential diagnoses for a perforated ulcer. These conditions can present with similar symptoms and may require further evaluation to differentiate them from a perforated ulcer.

The correct answer includes the symptoms associated with Zollinger-Ellison syndrome, which are an increase in basal nocturnal secretion, frequent and acidic vomiting, frequent upper digestive tract bleeding, and intense and continuous epigastric pain with nocturnal exacerbations. These symptoms are characteristic of Zollinger-Ellison syndrome and help differentiate it from other conditions.