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Dentistry – Surgery IV Year Dentistry – Surgery IV year Which sign is not associated with peptic ulcer perforation: A 42-year-old male, with previous Sudden onset ulcer history and typical clinical picture of peptic ulcer perforation, on Cloiberg caps examination, in 4 hours after the Positive Blumberg sign beginning of the disease, discomfort in Free air below diaphragm on plain right upper quadrant, heart rate - abdominal film 74/min., mild abdominal wall muscles rigidity, negative Blumberg sign. Free Intolerable abdominal pain air below diaphragm on X-ray abdominal film. What is you diagnosis? Which ethiological factors causes Peptic ulcer recurrence peptic ulcer disease most oftenly? Acute cholecystitis Abdominal trauma, alimentary factor Chronic cholecystitis H. pylori, NSAID's Covered peptic ulcer perforation H. pylori, hyperlipidemia Acute appendicitis (subhepatic Drugs, toxins location) NSAID's, gastrinoma Most oftenly perforated peptic ulcers are located at: A 30-year-old male is operated on for peptic ulcer perforation, in 2,5 hours Posterior wall of antrum after the beginning of the disease. Fundus of stomach Which operation will be most efficient (radical operation for peptic ulcer)? Cardiac part of stomach Simple closure and highly selective Posterior wall of duodenal bulb vagotomy Anterior wall of duodenal bulb Simple closure Simple closure with a Graham patch Penetrated ulcer can cause such using omentum complications: 1). Abdominal abscess; Stomach resection 2). Portal pyelophlebitis; 3). Stomach- organ fistula; 4). Acute pancreatitis; 5). Antrumectomy Bleeding. 1, 2, 3; It has been abandoned as a method to treat ulcer disease 2, 3, 5; 1, 3, 5; A 42-year-old executive has refractory 3, 4, 5; chronic duodenal ulcer disease. His All physican has suggested several surgical options. The patient has chosen a parietal (highly selective) vagotomy A 45-year-old man complains of instead of a truncal vagotomy and burning epigastric pain that wakes him antrectomy because? up at night. The pain is relieved by eating or using over-thecounter It results in a lower incidence of ulcer antacids and H2 blockers. Diagnosis is recurrence best confirmed by which of the The complication rate is lower following? It reduces acid secretion to a greater Urea breath test extent Serum gastrin levels It benefits patients with antral ulcers Barium meal examination the most Upper endoscopy It includes removal of the ulcer Upper endoscopy and biopsy A 63-year-old woman is admitted to the hospital with severe abdominal pain A 44-year-old dentist complains of of 3-hour duration. Abdominal burning epigastric pain that wakes him examination reveals board-like rigidity, up at night caused by a recurrent guarding, and rebound tenderness. Her duodenal ulcer. He has shown blood pressure is 90/50 mm Hg, pluse considerable improvement following 110 bpm (beats per minute), and operative treatment by a truncal respiratory rate is 30 breaths per vagotomy and pyloroplasty, 10 years minute. After a thorough history and prior to this incident. Which is TRUE physical, and initiation of fluid of truncal vagotomy? resuscitation, what diagnostic study It is performed exclusively via the should be performed? thorax Supine abdominal x-rays It can be performed in the neck Upright chest x-ray If complete, it will result in increased Gastrograffin swallow acid secretion Computerized axial tomography (CAT) It requires a gastric drainage procedure scan of the abdomen Abdominal sonogram Cigarette smoking A frail elderly patient is found to have Rapid gastric emptying an anterior perforation of a duodenal High gastrin level ulcer. He has a recent history of nonsteroidal anti-inflammatory drug H2-blockers intake (NSAID) use and no previous history of peptic ulcer disease. A large amount of bilious fluid is found in the What we can find at abdominal abdomen. What should be the next examination of patient with perforated step? peptic ulcer: 1. abdominal wall muscles rigidity; 2. positive Blumberg sign; 3. Lavage and omental patch closure of guarding; 4. tenderness; 5. absence of the ulcer liver dullness. Choose the best Lavage of the peritoneal cavity alone combination. Total gastrectomy all are present Lavage, vagotomy, and 1,2,3 gastroenterostomy 1,2,4 Laser of the ulcer 1,3,5 2,3,4 Name 3 main signs of perforated peptic ulcer? Which statement, concerning Abdominal pain, multiple vomiting, perforated peptic ulcer, is NOT TRUE? distention of abdominal cavity Patient with a perforated peptic ulcer Increasing abdominal pain, meteorism, who has peritoneal signs should peritonitis undergo laparotomy Ulcer in past medical history, sudden Perforated peptic ulcers must be treated abdominal pain, board-like rigidity nonoperatively Ulcer in past medical history, pain in Patients with perforated peptic ulcer the epigastrium, which gradually usually present with a sudden onset of increases, peritonitis severe abdominal pain Abdominal pain, pale and cold skin, Free air under the diaphragm confirm low BPAbdominal pain, pale and cold the diagnosis of perforated peptic ulcer skin, low BP Perforation of posterior wall of stomach is seen very rarely What doesn't predispose to peptic ulcer disease? Steroid use Laboratory studies in patients with with Which ethiological factors causes perforated ulcer may include: 1. CBC; peptic ulcer disease most oftenly? 2. Serum gastrin level; 3. H. pylori Abdominal trauma, alimentary factor infection testing; 4. Urine analysis; 5. Serum human chorionic gonadotropin H. pylori, NSAID's levels. Coose correct answer. H. pylori, hyperlipidemia 1, 2, 3 Drugs, toxins 1, 3, 4 NSAID's, gastrinoma 1, 4, 5 2, 3, 5 A 30-year-old male is operated on for 2, 4, 5 peptic ulcer perforation, in 2,5 hours after the beginning of the disease. Which operation will be most efficient Nonoperative treatment of selected (radical operation for peptic ulcer)? patients with a diagnosis of perforated Simple closure and highly selective ulcer includes all the following, vagotomy EXCEPT: Simple closure NSAIDs Simple closure with a Graham patch Broad-spectrum antibiotics using omentum Proton pump inhibitor Stomach resection Fluid resuscitation with replacement of Antrumectomy fluid and electrolytes Nasogastric decompression A 42-year-old male, with previous ulcer history and typical clinical picture Which sign is not associated with of peptic ulcer perforation, on peptic ulcer perforation: examination, in 4 hours after the beginning of the disease, discomfort in Sudden onset right upper quadrant, heart rate - Cloiberg caps 74/min., mild abdominal wall muscles Positive Blumberg sign rigidity, negative Blumberg sign. Free air below diaphragm on X-ray Free air below diaphragm on plain abdominal film. What is you diagnosis? abdominal film Peptic ulcer recurrence Intolerable abdominal pain Acute cholecystitis Chronic cholecystitis Covered peptic ulcer perforation Acute appendicitis (subhepatic Upper endoscopy and biopsy location) A 44-year-old dentist complains of Most oftenly perforated peptic ulcers burning epigastric pain that wakes him are located at: up at night caused by a recurrent duodenal ulcer. He has shown Posterior wall of antrum considerable improvement following Fundus of stomach operative treatment by a truncal Cardiac part of stomach vagotomy and pyloroplasty, 10 years prior to this incident. Which is TRUE Posterior wall of duodenal bulb of truncal vagotomy? Anterior wall of duodenal bulb It is performed exclusively via the thorax Penetrated ulcer can cause such It can be performed in the neck complications: 1). Abdominal abscess; If complete, it will result in increased 2). Portal pyelophlebitis; 3). Stomach- acid secretion organ fistula; 4). Acute pancreatitis; 5). Bleeding. It requires a gastric drainage procedure 1, 2, 3; It has been abandoned as a method to treat ulcer disease 2, 3, 5; 1, 3, 5; A 42-year-old executive has refractory 3, 4, 5; chronic duodenal ulcer disease. His All physican has suggested several surgical options. The patient has chosen a parietal (highly selective) vagotomy A 45-year-old man complains of instead of a truncal vagotomy and burning epigastric pain that wakes him antrectomy because? up at night. The pain is relieved by It results in a lower incidence of ulcer eating or using over-thecounter recurrence antacids and H2 blockers. Diagnosis is best confirmed by which of the The complication rate is lower following? It reduces acid secretion to a greater Urea breath test extent Serum gastrin levels It benefits patients with antral ulcers the most Barium meal examination It includes removal of the ulcer Upper endoscopy A 63-year-old woman is admitted to Name 3 main signs of perforated peptic the hospital with severe abdominal pain ulcer? of 3-hour duration. Abdominal Abdominal pain, multiple vomiting, examination reveals board-like rigidity, distention of abdominal cavity guarding, and rebound tenderness. Her blood pressure is 90/50 mm Hg, pluse Increasing abdominal pain, meteorism, 110 bpm (beats per minute), and peritonitis respiratory rate is 30 breaths per Ulcer in past medical history, sudden minute. After a thorough history and abdominal pain, board-like rigidity physical, and initiation of fluid resuscitation, what diagnostic study Ulcer in past medical history, pain in should be performed? the epigastrium, which gradually increases, peritonitis Supine abdominal x-rays Abdominal pain, pale and cold skin, Upright chest x-ray low BPAbdominal pain, pale and cold Gastrograffin swallow skin, low BP Computerized axial tomography (CAT) scan of the abdomen What doesn't predispose to peptic ulcer Abdominal sonogram disease? Steroid use A frail elderly patient is found to have Cigarette smoking an anterior perforation of a duodenal Rapid gastric emptying ulcer. He has a recent history of nonsteroidal anti-inflammatory drug High gastrin level (NSAID) use and no previous history H2-blockers intake of peptic ulcer disease. A large amount of bilious fluid is found in the abdomen. What should be the next What we can find at abdominal step? examination of patient with perforated Lavage and omental patch closure of peptic ulcer: 1. abdominal wall muscles the ulcer rigidity; 2. positive Blumberg sign; 3.
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