ページ1:

In a RISK
malignant
Type vos.
gastric
Ann. pernicio
Cytekine: LTBy
type ro Gastric Ulcer
type I
lesser arve.
- typell. GU+ DU.
-type-piepklic.
MODIFIED JOHNSON
Weak mucosal✔
Acid hyper secre tich => Vagotomy w
lesser curve Weak mucosal
-type N-- high on
(prox. stomach)
-type V. - uua-
Ulcer
ตาม
modified
ยารักษ
John sch.
ยามา H pelori
NSAID.V
H. pylori
→ 800 ×2.
.
PPI + Clarithro+
Amexi (ce my my
bid)
CAPTAN
PY LOLI.
(600)
ยผ้
Ppl clarithro + Metronidazole 200 x 3.
7
| (1907) Chicnic PU

ページ2:

Kaotomy
มักแบบ
0:
Complication
10 bilroth
I no 9
vagotung / Gastrectomy
Vagotomy
ma Vagus N.
Jun 1) truncal (m)
->>
→ 1015 w garlic emplying
2) se tective :mn division vie
~1.5m leaks
antrum Amic duo
30 hilphly selective emptying (Proximal)
gastrectomy
• subtotal
- total
->
(Billroth I (gastroduodenostomy) =>mo
Billroth II (qastro jejures tomy) => -ujo duc denal
esophago duodenestemy (Identian)
Mono/cjejunum
sics NJ tube
esophage geu nes lemy. Ju no bile nu reflux esophagitis

ページ3:

- ถั่วเน
gastric
ulcer.
90567
อะไร ๆ
PU bleeding
005 ddx
709509
- In 174
7x :
X
Comental patch (graham patch)
graft
LABelite
1
ไป
}.
TX-an
-bal
BIC PSY
Yo
* highly selective vagotomy
tioncal vagotomy + pylreplasty
154 gashve lcer =>
Scar Su
P Pu bleeding 25: on, melena, hem alochejia
ATX: resuscitation => EED =>
(ภาพใน 24 ชม)
nime epinephrine jact
Inte
=> lesion cy
pick skach
DX Mallery-weiss tear. Consus submucosal vessel nnn.
diculation lesson. submocosa wau
endoscope we sno
no fibrin glue / clip adclame.
SK: tanul vaqo1 pyroplasty.: non bleeding DU
lolal
qashect eclive gastritis
Nedge ulcer resection. / gastrectomy: GU
Angiography
embelizala
wedge
resen

ページ4:

♥ partial
2 bleeding.
» destrulin
1 for x
4/ Poskwal lauke INTRACTIBILITY
Pepe keer perforate
-bleeding
36 pain, w/V, peritonitis, dicture done =) si
- Peptic
ex
ucer
pertate.
595
ĥs 12 hu
treatment
dx
He 9
do 9
Sign peritonitis
/acute red tail
Sepsis
gastric
-585 l
MIC
12 hr.
2x
PE:-
•
- กาเยน
gastric
ulcer.
ควรทา
0:759
PU bleeding
free mir Juowner.
- 194
7x :
X
omental patch (graham patch)
graft
17
hilu
pylere plenty
}
2/4411)
*
highly selective vagotomy.
#funcal vagotomy +
: gastric ulcer =>
Scar S
BIO PSY
1401:
Po bleeding SES: on, melena, hem alochejia
Pain
LA

ページ5:

การ เอ็น 1 to
12 hr.
-ฤษได้ย)
24.
ne nject
tx xC)
gastric
Out let
obstruction
3) spaim
4) Inflammatio.
5) phluic dysmaility
dx cad. saline loading AU 700 cc. >04Jom balu bomin)
PE: W loss
volume deplet
Splashing sound CM 3.)
Plain film
enlarge gashic bubble.
LAS elite hypo cl à mel alka.
anemia
· 1 serum gastrin level. Malignant.
(dou-800)
tumor marker CA19-9
TX: anti secretary trapy.
balloon dilation.
CEA.
Vagotomy & antecky.
vagotomy & drainage.
Intractability Inan healing
00
reando antent
54 350.
obstruction.
1155 To Im
fluid resus.
order. for I day
NOO
• Decument ulceroy.
Saline leading test.
lavage NG mu
Wein dentent can.
100 720 Mics Surgical
oh benign do mortigun

ページ6:

obstruction
gastric ullet obstruction
anorexia,
epigastric pair,
pest pintal vent.
I projectile vent)
MIC w obstruct : duodenal ulcer in fibici, ciducian)
-585: 27
1775 MA
2009
INC
diag.
EGD
, 150,
10:75 9
S u ไA to
12 hr.
tx xc)
gastric
Out let
2) Malignany
3) spaim
4) Inflammatio.
5) phluic dysmaility.
cqd. saline leading Asid 700 co.
dx
PE:-W less
volume deplet
Splashing sound Ch
Plain film enlarge qashic bubble.
LAB-elite
hypo cl mel alka.
anemia PU
>oom in lalu bomin)
headuno antent
54 350.
Nous obstruction.
obstruction
1 serum
gastrin
level.
Malignant.
(400-800)
tumor marker CAM-9
TX: anti secretory therapy.
11 Jum
fluid resus.
CEA.
order for 1 day
NOW