Duodenum Disease

Duodenal Ulcer
A duodenal ulcer is a type of peptic ulcer that occurs in the duodenum.

Symtoms

• Abdominal bloating, Belching, Feeling of fullness
• Nausea, vomiting
• Unexplained weight loss
• Anorexia
• Burning in stomach
• Upper abdominal pain
• Bloody, tarry stool
• Haemetemesis

Causes

• H Pylori Bacteria
• Alcohol
• Tobacco
• NSAIDs
• Radiation Therapy
• Stress, severe illness

Treatment

• Lifestyle changes such as avoiding oily, spicy foods. Avoid smoking, alcohol and NSAIDS.

Antibiotics

• Proton Pump inhibitors
• Histamine H2-receptor antagonists

Complications

• Perforated duodenal ulcer, which can lead to bleeding
• Internal haemorrhage
• Spread of infection
• Cancer of duodenum

Superior mesenteric artery (SMA) syndrome is a life-threatening gastro – vascular disorder caused by a compression of the third and final portion of the duodenum by the abdominal aorta (AA) and the overlying superior mesenteric artery.

 

Sign and Symptoms

• Severe postprandial epigastric pain
• Nausea, vomiting
• Early satiety
• Eructations
• Abdominal distention with tenderness
• Diarrhoea
• Subacute small intestinal obstruction
• Symptoms relieved in the left lateral or knee-to-chest position, or in the prone position. Symptoms can be aggravated in right orsupine(face up) position.
• Succussion splash on abdominal examination

Cases

• Aesthenic (thin) body built
• Visceroptosis
• Lax abdominal wall
• Lumbar lordosis, scoliosis
• Anorexia Nervosa
• Cachexia
• Abdominal trauma
• Burns
• Retroperitoneal tumours
• Cancer
• Starvation
• Malabsorption
• Prolonged supine bed rest
• Spinal cord injury
• Scoliosis surgery
• Left nephrectomy, ileo-anal pouch surgery
• Dietary disorders
• Anatomic anomalies- High and fixed position of the ligament of Treitz with an upward displacement of the duodenum, intestinal malrotationaround an axis formed by the SMA.
• Unusually low origin of SMA.
• Familial superior mesenteric artery syndrome
• Traumatic aneurysm of the superior mesenteric artery after a stab wound
• Recurrent superior mesenteric artery syndrome
• Abdominal aortic aneurysms and mycotic aortic aneurysms

Diagnosis

• Upper GI scopy
• Colonoscopy
• X Ray Abdomen
• USG Abdomen
• CT Scan
• CT Angiography
• Upper GI series
• Hypotonic Duodenography

Treatment

• Resolution of underlying conditions, reversal or removal of precipitating factor and weight gain.
• Adequate nutrition, fluids and electrolytes replacement either by inserting jejunal feeding tube, nasogastric intubation or peripherally inserting central catheter (PICC line) administering total parenteral nutrition (TPN).
• Proper positioning of the patient after eating (ie, left lateral decubitus, prone, knee-to-chest position).
• Daily monitoring of patient’s weight.
• Orally liquids can be started followed by slow and gradual introduction of small and frequent soft meals as per patient’s tolerance.
• Prokinetic agents such as Metoclopramide.
• Surgery- Duodenojejunostomy or Gastrojejunostomy.

Complications

• Dehydration
• Electrolyte imbalance (eg, hypokalemia, hypochloremia, metabolic alkalosis)
• Oliguria
• Hypotension
• Malnutrition
• Aspiration pneumonia
• Peptic ulcer disease

Duodenal perforation

Duodenal perforation is an uncommon complication of endoscopic retrograde cholangio-pancreatography (ERCP) and a rare complication of upper gastrointestinal endoscopy.

Causes

• Blunt abdominal trauma.
• Penetrating injury to the lower chest or abdomen (e.g. stab injuries).

Bacterial infections

• Ingestion of aspirin, non steroidal anti-inflammatory drugs (NSAIDs), and steroids.
• Inflammatory bowel disease (IBD).
• Predisposing conditions – Peptic ulcer disease, acute appendicitis, acute diverticulitis, and inflammed Meckel diverticulum.
• Endoscopy related bowel injuries- Endoscopic biliary stenting, Colonoscopy, ERCP.
• Laparoscopic intestinal injury.
• Bowel perforation by intra-abdominal malignancy, lymphoma, or metastatic renal carcinoma – Even benign tumours, such as desmoid tumours.
• Radiotherapy of cervical carcinoma and other intra – abdominal malignancies.
• Perforation secondary to intestinal ischemia (e.g. ischaemic colitis)
• Necrotizing vasculitis.
• Kidney transplantation
• Foreign bodies (e.g. toothpicks).
• Ingestion of caustic substances – Accidental or suicidal ingestion.

Signs and Symptoms

• Abdominal pain- Sharp, severe, sudden in onset.
• Vomiting
• Hiccoughs
• Board-like rigidity of abdomen with tenderness
• Tachycardia
• Fever
• Absence of bowel sounds

Diagnosis

• CBC
• LFT
• RFT
• Blood culture
• X Ray Abdomen Erect
• Chest PA
• USG Abdomen
• CT Scan
• Laparoscopy

Treatment

• Intravenous access, and crystalloid therapy in patients with clinical signs of dehydration or septicaemia.
• Do not give anything by mouth.
• Intravenous administration of antibiotics.
• Surgery

Complications

• Localized abdominal abscess
• Wound infection
• Mechanical intestinal obstruction
• Postoperative delirium
• Multi organ failure
• Gastrointestinal mucosal hemorrhage
• Fluid and electrolyte imbalance
• Renal failure
• Septic shock

Introduction

Duodenal cancer is a cancer of first part of the intestine called duodenum, which is a vital organ of digestive tract where bile juice, pancreatic juice and gastric juice are mixed and act on food material.

Risk Factors

• High Fat Diet
• Crohn’s disease
• Celiac disease
• Duodenal ulcer
• Juvenile polyposis syndrome
• Familial adenomatous polyposis (FAP)
• Muir -Torre syndrome- inherited disease caused due to genetic defect.
• Peutz-Jeghers syndrome – Inherited autoimmune disease.

Symptoms

• Heart burn, regurgitation
• Nausea, vomiting
• Bloating
• Weight loss
• Fatigue, generalised weakness
• Abdominal pain
• Melaena

Investigations

• CT Scan
• X Ray Abdomen
• UGI Endoscopy with biopsy

Treatment

• Treatment depends on patient’s age, health status and cancer stage.
• Surgery
• Chemotherapy