| Stress ulcers: their pathogenesis, diagnosis, and treatment. | |
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MedLine Citation:
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PMID: 793064 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Stress ulcers are multiple, superficial erosions which occur mainly in the fundus and body of the stomach. They develop after shock, sepsis, and trauma and are ofter found in patients with peritonitis and other chronic medical illness. Stress ulcers should be differentiated from reactivation of chronic duodenal or gastric ulcers. Cushing's ulcer following head injury, or drug-induced gastritis. Digestive symptoms are usually absent, hemorrhage is the most common manifestation, and perforation and obstruction are rare. The presence of luminal acid and ischemia are necessary for the production of stress ulcer, while disruption of the gastric mucosal barrier by refluxed duodenal content may contribute to the pathogenesis. Endoscopy is the mainstay of the diagnostic procedure, and angiography should be used if endoscopy fails to identify the bleeding lesions. Medical management should include volume replacement, nasogastric aspiration, and the use of antacid. Selective intraarterial infusion of pitressin has shown encouraging preliminary results. Surgical treatment is reserved only for those patients who continue to bleed despite all medical management. The operation of choice is open to question. We prefer vagotomy, pyloroplasty, and oversewing the ulcers as an initial operation. Since the result of all forms of therapy has been poor, it seems resonable to try to prevent ulcer development. The use of vitamin A, hyperalimentation, and growth hormones is still in an experimental stage. Large clinical studies with case control are necessary before recommendations can be made. The use of potent and frequent antacid to buffer the gastric content has shown promising results; however, these observations need to be confirmed in a properly controlled and randomized study. |
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Authors:
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F G Moody; L Y Cheung |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: The Surgical clinics of North America Volume: 56 ISSN: 0039-6109 ISO Abbreviation: Surg. Clin. North Am. Publication Date: 1976 Dec |
Date Detail:
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Created Date: 1977-01-29 Completed Date: 1977-01-29 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0074243 Medline TA: Surg Clin North Am Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1469-78 Citation Subset: IM |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Gastric Mucosa
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physiopathology Humans Ischemia / complications Peptic Ulcer / diagnosis, etiology*, therapy Permeability Stomach / blood supply Stress, Physiological / complications*, physiopathology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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