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Duodenal Disease

Disease of Duodenum


Presentation

  • If no liver disease is present, endoscopy with planned hemostasis of a presumed ulcer can be planned.[clinicaladvisor.com]
  • Session: Poster Presentation Program Number: P227 Post Views: 411 Related « Return to SAGES 2013 abstract archive[sages.org]
  • The present study was done to determine if the site of duodenal cap ulcers had any correlation to its presentation, healing or relapse rates in our patient population.[jpma.org.pk]
  • They can either erode into blood vessels causing upper GI bleeds which present with haematemesis and/or meleana. These patients may have epigastric discomfort, but they do not present with acute abdominal pain.[ole.bris.ac.uk]
  • Treatment and prognosis Treatment depends on the clinical presentation.[radiopaedia.org]
Familial Adenomatous Polyposis
  • BACKGROUND: Although only 5 per cent of patients with familial adenomatous polyposis (FAP) die from duodenal cancer, a recent study indicated that the mortality rate is much higher in patients with Spigelman stage IV disease.[ncbi.nlm.nih.gov]
  • Abstract Duodenal polyposis is found in the majority of patients with familial adenomatous polyposis.[ncbi.nlm.nih.gov]
  • Familial Adenomatous Polyposis, often shortened to FAP, is an inherited disease that causes 1 percent of all colorectal cancers and can occur in the duodenum.[livestrong.com]
Neonatal Intestinal Obstruction
  • Neonatal intestinal obstruction. East Mediterr Health J. 2000;6:187-93. Lawrence MJ, Ford WD, Furness ME, et al. Congenital duodenal obstruction: ealy antenatal ultrasound diagnsosis. Pediatr Surg Int. 2000;16:342-45.[rarediseases.org]
Abdominal Pain
  • A high degree of clinical suspicion must be used to properly assess abdominal pain in a puerperium female even though non-specific abdominal pain is experienced postpartum by 98% and 92% of primiparous and multiparous women respectively.[sages.org]
  • Symptoms of Crohn’s include diarrhea, rectal bleeding, abdominal pain, weight loss, fevers and joint pain. While medications such as steroids to reduce inflammation or antibiotics can help control Crohn’s disease, no cure exists.[livestrong.com]
  • Plain radiograph Abdominal films have little role in the setting of vague/chronic upper abdominal pain, and have a very low yield.[radiopaedia.org]
  • These patients may have epigastric discomfort, but they do not present with acute abdominal pain. Or peptic ulcers can erode through the mucosa to cause a bowel perforation.[ole.bris.ac.uk]
  • Most people with a duodenal ulcer experience upper abdominal pain and sometimes nausea or vomiting. An upper gi endoscopy will be able determine the extent of ulceration.[westkentgastro.com]
Nausea
  • Less common symptoms include: Belching Nausea Vomiting Poor appetitie Weight loss Difficulty feeding Blood in the stools or vomit Feeling tired and weak A person of any age can get an ulcer.[giforkids.com]
  • Most people with a duodenal ulcer experience upper abdominal pain and sometimes nausea or vomiting. An upper gi endoscopy will be able determine the extent of ulceration.[westkentgastro.com]
  • Disruption of this balance caused by too much acid (or weakened defense) can result in erosions or ulcers with symptoms including upper abdominal pain, indigestion or heartburn, nausea and/or vomiting.[ddc.musc.edu]
  • […] is more common than gastric ulcers. typically in age 25-30 what is duodenal ulcer associated with smoking alcholo NSAIDs H.pylori (85%) cyclical pain develops 1-3h after meal hunger pain and central back pain pain is relieved by eating or anatacids nausea[quizlet.com]
Epigastric Pain
  • pain, radiating to the back.pain is unreleated to mealds.[quizlet.com]
  • Epigastric pain is a typical symptom of PUD, however, some patients may remain asymptomatic. Diagnosis occurs via direct visualization of the ulcer on esophagogastroduodenoscopy ( EGD ) and H. pylori detection (via biopsy or non-invasive testing).[amboss.com]
  • Dyspepsia can include pain in the upper abdominal region ("epigastric" pain), an early feeling of fullness, nausea, and even vomiting.[courses.washington.edu]
  • Although epigastric pain was the commonest presenting symptom in all the patients, it was significantly more frequent in those with an anterior wall ulcer (Table II).[jpma.org.pk]
  • Clinical features As in duodenal ulceration the usual presentation is epigastric pain. The pain is typically exacerbated by food; nausea, unremitting pain and weight loss are common.[surgwiki.com]
Lower Abdominal Pain
  • However, anything other than intermittent mild colicky lower abdominal pain is abnormal and careful analysis must be taken.[sages.org]
Rectal Bleeding
  • Symptoms of Crohn’s include diarrhea, rectal bleeding, abdominal pain, weight loss, fevers and joint pain. While medications such as steroids to reduce inflammation or antibiotics can help control Crohn’s disease, no cure exists.[livestrong.com]
Vascular Disease
  • It usually remains for five to seven days and heals within two weeks with no scarring. chronic leg ulcer ulceration of the lower leg caused by peripheral vascular disease involving either arteries and arterioles or veins and venules of the affected limb[medical-dictionary.thefreedictionary.com]
Epistaxis
  • Differential diagnosis Epistaxis – evaluate for nasopharyngeal source Variceal UGI bleeding – see Liver Chapter – evaluate for liver disease Foreign body – often present for weeks Mallory-Weiss tear – if history of vomiting is present 4.[clinicaladvisor.com]

Workup

  • Provides all the necessary tools to make a comprehensive diagnostic workup including data from ancillary techniques and molecular findings whenever appropriate.[books.google.com]

Treatment

  • Similar to other treatments for CD, the objective is to avoid surgical treatment as long as possible in order to prevent short bowel syndrome and other complications related to surgical resection.[healio.com]
  • Ulcer with clean base – NO ENDOSCOPIC TREATMENT – medical managment.[clinicaladvisor.com]
  • Treatment Treatment should be determined by your doctor and may include: Lifestyle changes – no particular diet is helpful for most ulcer patients. Limit or avoid foods that cause you heartburn or indigestion.[giforkids.com]
  • Surgical treatment for congenital duodenal obstruction. J Med Assoc Thai. 2001;84:842-49. Inasir GA, Rahma S, Kadim AH. Neonatal intestinal obstruction. East Mediterr Health J. 2000;6:187-93. Lawrence MJ, Ford WD, Furness ME, et al.[rarediseases.org]
  • Five new chapters, additional expert authors, expanded tables, and coverage of the current clinical approach to management and treatment options, particularly screening and surveillance recommendations for preneoplastic disorders, round out this unique[books.google.com]

Prognosis

  • Prognosis The prognosis of an adequately treated peptic ulcer in children is excellent. Copyright 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.[clinicaladvisor.com]
  • Treatment and prognosis Treatment depends on the clinical presentation.[radiopaedia.org]
  • The poor prognosis of gastric cancer also makes ascertainment bias an unlikely explanation.[nejm.org]
  • Helicobacter pylori-negative duodenal ulcers: prevalence, clinical characteristics and prognosis-result from a randomised trial with 2-year follow-up. Am J Gastroenterol 2001;96:1409-16. 29. Qureshi A, Jamshaid, Siddiqui M, Zafar SA.[pjmhsonline.com]

Etiology

  • Etiology Risk factors Chronic gastritis caused by H. pylori, a curved, flagellated gram-negative rod Duodenal ulcers : up to 90% are due to H. pylori infection Gastric ulcers : up to 80% are due to H. pylori infection Chronic gastritis of other etiology[amboss.com]
  • […] is unknown, but spirochetes, fusiform bacilli, and other bacteria are often present in the developing lesion, and protein and vitamin deficiency with lowered resistance to infection may play a role in the etiology. venereal ulcer a nonspecific term referring[medical-dictionary.thefreedictionary.com]
  • Etiology of duodenal ulcer. I. Relation of specific psychological characteristics to rate of gastric secretion (serum pepsinogen) Psychosomatic Medicine 19 ( 1 ), 1 – 10 . Wolcott , D. L. , Wellis , D. K. , Robertson , C. R. & Arthur , R.[cambridge.org]
  • Etiology of the ulcer disease was determined in 15 of the children, but the cause was unknown in 12. Our series is concerned only with duodenal ulcers which, admittedly, comprise the greatest percentage of peptic ulcers.[pediatrics.aappublications.org]

Epidemiology

  • The epidemiology is then described followed by the main clinical as sociations, which are gastritis and dyspepsia, peptic ulcers, can cers and lymphoma.[books.google.com]
  • -E.H.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Md. (A.W.H., J.F.F.); the International Epidemiology Institute, Rockville, Md. (W.[nejm.org]
  • Curbside Consultation Linda Tang, MD Previous epidemiological studies have shown that Crohn’s disease (CD) is limited to the small bowel in 31% of patients. Most of the small bowel disease is located in the ileum.[healio.com]
  • American Journal of Epidemiology 111 ( 1 ), 37 – 58 . Jackson , D. N. ( 1967 ). Personality Research Form Manual . Research Psychologists Press : New York . Jenkins , C. D. , Rosenman , R. H. & Friedman , M. ( 1967 ).[cambridge.org]
  • Epidemiology References: [1] [2] [3] [4] [5] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
Sex distribution
Age distribution

Pathophysiology

  • General Considerations • 2-3 times more frequent than gastric ulcers • 3:1 male :female ratio Pathophysiology • Excessive acidity in duodenum from • Abnormally high gastric secretion • Inadequate neutralization Predisposing factors • Steroids • Severe[learningradiology.com]
  • References: [12] Pathophysiology Clinical features Gastric ulcer Duodenal ulcer Findings common to both Dyspepsia : postprandial heaviness, early satiety, and gnawing, aching or burning epigastric pain Pain relief with antacids Potential signs of internal[amboss.com]
  • Pathophysiology: The duodenal mucosa resists damage from theeffect of aggressive factors, such as gastric acid and theproteolytic enzyme pepsin, with the help of several protectivefactors such as a mucous layer, bicarbonate secretion, andprotective prostaglandins[gastrointestinalatlas.com]

Prevention

  • Preventing duodenal cancer, the second leading cause of death in FAP patients, requires frequent removal and biopsy of polyps that develop.[livestrong.com]
  • Destruction of this organism with antibiotics, together with the use of proton pump inhibitor drugs such as OMEPRAZOLE (Losec), has been shown to cure many ulcers and to prevent recurrence.[medical-dictionary.thefreedictionary.com]
  • Similar to other treatments for CD, the objective is to avoid surgical treatment as long as possible in order to prevent short bowel syndrome and other complications related to surgical resection.[healio.com]
  • A diet that eliminates food allergens has been used with great success in treating and preventing recurrent duodenal or gastric ulcers (see Food Allergy). It is especially important to avoid milk and dairy products.[doctormurray.com]

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