Enfermedad acidopeptica 2012
Transcript of Enfermedad acidopeptica 2012
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ENFERMEDADACIDOPEPTICA
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ENFERMEDAD ACIDOPEPTICA
COMPRENDE TODAS AQUELLAS LESIONES QUE SE DESARROLLAN EN LAS PORCIONES DEL TUBO DIGESTIVO EXPUESTAS A LA ACCION DEL ACIDO CLORHIDRICO Y LA PEPSINA
UNO DE LOS PADECIMIENTOS MAS FRECUENTES DEL TUBO DIGESTIVO
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ENFERMEDAD ACIDOPEPTICA
SU LOCALIZACION MAS FRECUENTE ES
EN EL DUODENO, LUEGO ESTOMAGO Y
ESOFAGO
PUEDEN SER UNICAS O
MULTIPLES
EXISTE ULCERA ANASTOMOTICA
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ENFERMEDAD ACIDOPEPTICA
ETIOLOGIA MULTIFACTORIAL (alcohol,infecciones,psicológicos,hormonales,AINES)
Del 5 al 10% de la poblacion adulta padece o la ha padecido
Más frecuente en hombres 2:1
Uno de cada 8 estadounidenes padece alguna modalidad de EAP
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EDADES DE PRESENTACION
ULCERA GASTRICA: 50 A
89 AÑOS
ULCERA DUODENAL: 30
A 69 AÑOS
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E.A.P Y HELICOBACTER
ULCERA DUODENAL: 95%
ULCERA GASTRICA:75%
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LA PRESENCIA DE HELICOBACTER SE ASOCIA
A UNA RESPUESTA INFLAMATORIA QUE
ALTERA LA ARQUITECTURA NORMAL Y LOS
MECANISMOS DE DEFENSA
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DAÑO A LA ARQUITECTURA EPITELIAL
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FISIOPATOLOGIA
PERDIDA DEL EQUILIBRIO ENTRE LOS FACTORES AGRESIVOS Y DEFENSIVOS
UNA TERCERA PARTE DE LAS ULCERAS DUODENALES PRODUCE UN
EXCESO DE ACIDO CLORHIDRICO, DEBIDO A UN AUMENTO EN LA MASA DE CELULAS PARIETALES
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FACTORES DE RIESGO
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CUADRO CLINICO
DOLOR EPIGASTRICO
SENSACION DE HAMBRE DOLOROSA
NAUSEAS Y VOMITOS
HEMATEMESIS O MELENA
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CARACTERISTICAS DEL DOLOR
ULCERA GASTRICA
• EPIGASTRICO
• POSTPRANDIAL TEMPRANO
• SENSACION DE VACIO O HAMBRE DOLOROSA
• DOLOR INTENSO= COMPLICACION
ULCERA DUODENAL
• EPIGASTRICO
• POSTPRANDIAL TARDIO
• SENSACION DE HAMBRE DOLOROSA
• LEVE A MODERADA INTENSIDAD
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MANIFESTACIONES ATIPICAS
UN CUADRO DE ABDOMEN AGUDO POR
PERFORACION O HEMORRAGIA PUEDE
SER LA PRIMERA MANIFESTACION DE UNA
ULCERA “SILENCIOSA”
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DIAGNOSTICO
CLINICO ENDOSCOPICO RADIOLOGICO
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ENDOSCOPIA
• ESTABLECE EL DIAGNOSTICO
• TOMA BIOPSIAS
• TERAPEUTICA EN CASO DE SANGRADO
• INFORMA SOBRE PILORO
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ENDOSCOPIA
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ULCERA DUODENAL
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ULCERAS EN FUNDUS
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RADIOLOGICO
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COMPLICACIONES
HEMORRAGIA
PERFORACION
PENETRACION
OBSTRUCCION
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HEMORRAGIA
ES LA COMPLICACION
MAS FRECUENTE
PUEDE CAUSAR SHOCK
HIPOVOLEMICO Y HASTA LA MUERTE
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HEMORRAGIA
LA ENDOSCOPIA ES DIAGNOSTICA Y PUEDE LLEGAR A SER TERAPEUTICA
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PERFORACION
ABDOMEN EN MADERA
URGENCIA QUIRURGICA
NO REALIZAR ENDOSCOPIA
TELE DE TORAX
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TRATAMIENTO
IDENTIFICAR FACTORES ETIOLOGICOS
PERFIL PSICOLOGICO
PROFESION U OCUPACION
HORARIO DE ALIMENTACION
TABAQUISMO Y ALCOHOLISMO
INGESTA DE MEDICAMENTOS
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OBJETIVOS DEL TRATAMIENTO:
EVITAR EL DOLOR
LOGRAR CICATRIZACION
ERRADICAR LA CAUSA
EVITAR COMPLICACIONES
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DIETA:
NO IRRITANTES
HORARIO FIJO
DIETA FRACCIONADA
EVITAR VINAGRE,CITRICOS, ALCOHOL,CAFÉ,TABACO
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TRATAMIENTO
INHIBIDOR DE BOMBA DE PROTONES
SUCRALFATO
CISAPRIDA
ELIMINAR FACTOR ETIOLOGICO
ERRADICACION DE HELICOBACTER
EN CASO DE COMPLICACION TRATAMIENTO QUIRURGICO
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TRANQUILIZANTES:
EN AQUELLOS PACIENTES EN
QUE SE IDENTIFIQUE UN FACTOR
PSICOLOGICO QUE INFLUYA
COMBATIR INSOMNIO
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PSICOTERAPIA:
EL ENFERMO ULCEROSO ES UN SUJETO INTELIGENTE, INQUIETO, EMPRENDEDOR Y ACTIVO QUE CON FRECUENCIA ESTA SUJETO A ESTADOS DE TENSION EMOCIONAL INTENSA QUE NO PUEDE CONTROLAR O CANALIZAR
LA SIMPLE CANALIZACION DE ESTE ESTADO TENSIONAL,EL COMENTARIO DISCRETO DEL MEDICO,LA EXPLICACION DE SU INFLUENCIA SOBRE EL DESARROLLO DE LA ULCERA, RESULTAN DE GRAN VALOR EN EL TRATAMIENTO
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ULCERA GASTRICA CICATRIZADA
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HEMORRAGIA
ENDOSCOPIA: ES DIAGNOSTICA Y PUEDE SER TERAPEUTICA
SEGÚN REPORTE DE ENDOSCOPIA SE DECIDIRA MANEJO QUIRURGICO
GASTROTOMIA CON LIGADURA DE VASO SANGRANTE
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PERFORACION
LAPAROTOMIA INMEDIATA
PARCHE DE GRAHAM
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TRATAMIENTO A LARGO PLAZO
EN CASO DE RECIDIVA CON FRECUENCIA
HEMORRAGIA COMO PRIMERA MANIFESTACION
SUJETOS CON STRESS CONTINUO
RANITIDINA: 150 mg cada 12 a 24 hrs
Omeprazol 20 mg cada 24 hrs
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TRATAMIENTO QUIRURGICOOBJETIVOS:
CICATRIZACION DE LA ULCERA
EVITAR RECURRENCIA
MINIMOS EFECTOS
COLATERALES
MINIMA MORTALIDAD
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INDICACIONES DE TRATAMIENTO QUIRURGICO
ULCERA DUODENAL
• ESTENOSIS PILORICA
• HEMORRAGIA GRAVE DE REPETICION
• ULCERAS PENETRADAS
• ULCERAS PERFORADAS
• FALTA DE RESPUESTA AL TRATAMIENTO MEDICO BIEN LLEVADO
ULCERA GASTRICA
• ULCERAS PENETRADAS
• ULCERAS GIGANTES QUE DEFORMAN PILORO Y DIFICULTAN VACIAMIENTO
• FALTA DE RESPUESTA A TRATAMIENTO MEDICO
• SOSPECHA DE MALIGNIDAD
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ULCERA DUODENAL
VAGOTOMIA TRONCULAR: corte de ambos nervios vagos a nivel del esófago
inferior. Requiere de piloroplastía.
VAGOTOMIA SELECTIVA: sección de las ramas gástricas. Requiere piloroplastía.
VAGOTOMIA ALTAMENTE SELECTIVA: secciona solo ramas que van a cuerpo y
fondo. No piloroplastía-
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PILOROPLASTIA
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VAGOTOMIAS
REDUCEN LA SECRECION
ACIDA
MORTALIDA DE >1% EN
MENORES DE 60 AÑOS
RARA LA RECIDIVA
ULCEROSA
PILOROPLASTIA EN CASO
NECESARIO
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GASTRECTOMIAS
ANTRECTOMIAS CON
REPARACION TIPO BILLROTH
ANALISIS DE LA ULCERA
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CATEDRA DEBILLROTH
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OSTRUCCION PILORICA
GASTROYEYUNOANASTOMOSIS EN OMEGA DE BROWN
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