Thesis Cover Pages Dr. K. Raghu

A CLINICAL STUDY OF DUODENAL ULCER PERFORATION

DISSERTATION SUBMITTED TO Dr. N.T.R. UNIVERSITY OF HEALTH SCIENCES, VIJAYAWADA, A.P. IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF

MASTER OF SURGERY IN

GENERAL SURGERY APRIL 2010

By

Dr. K. RAGHU

DEPARTMENT OF SURGERY

KAKATIYA MEDICAL COLLEGE WARANGAL – A.P. 2010

DEPARTMENT OF SURGERY

KAKATIYA MEDICAL COLLEGE WARANGAL

CERTIFICATE

This is to certify that this Dissertation entitled “ A Clinical Study of Duodenal Ulcer Perforation” submitted in partial fulfillment of the requirement for the award of the degree of Master of Surgery in General Surgery of N.T.R. University of Health Sciences, Andhra Pradesh is a bonafide dissertation work carried out by Dr. K. Raghu.

Dr. M. Satyadev M.S. Professor and Head of the Department of Surgery Kakatiya Medical College Warangal., A.P. Date : Place : Warangal

DEPARTMENT OF SURGERY

KAKATIYA MEDICAL COLLEGE WARANGAL

CERTIFICATE

This is to certify that this Dissertation entitled “A Clinical study of Duodenal Ulcer Perforation” submitted in partial fulfillment of the requirements for the award of Degree of Master of Surgery in General Surgery of N.T.R University of Health sciences, Andhra Pradesh is a bonafide dissertation work carried out by Dr. K. Raghu under my guidance and supervision in the surgical wards of Mahatma Gandhi Memorial Hospital, Warangal.

Dr. K. Ramakrishna M.S. Professor of surgery, Kakatiya Medical College, Warangal, A.P. Date : Place : Warangal

ACKNOWLEDGMENT I wish to express my deep regard and thankfulness to Dr.M.Satyadev. M.S., Professor and Head of the Department of surgery and Dr. B. Karunaker Reddy M.S. Professor of surgery. and Dr.D.Ramesh, M.S .Professor of surgery, Dr. R. Ashok Reddy, M.S. Professor of surgery, Dr. S. Ramchander. M.S. Retired Professor of surgery, Kakatiya Medical College, Warangal for their whole hearted encouragement and valuable guidance for the preparation of this dissertation. I sincerely convey my gratitude and respect to my teacher and guide Dr. K. Ramakrishna, M.S. Professor of surgery for initiating me to undertake this topic for my dissertation. I am highly indebted to him for his excellent guidance, constant encouragement, meticulous care and constructive criticism in shaping this dissertation throughout the period of study, and without whose help this work could not have been completed. I express my deep regard and thankfulness to Dr. K. Laxman Murthy, M.S, Dr. Krishna Kishore, M.S. Associate Professors of surgery who have been constant source of inspiration and encouragement in carrying out this work. I express my regard and thankfulness to Dr. H. Suresh Climant, M.S.., Dr. M. Venkanna, M.S., Dr. K. Praveen Kumar, M.S., Asst. Professors of sugary and all my teachers who helped me and encouraged me in carrying out this work .I owe my sincere thanks to them for their timely suggestions and guidance. I wish to thank my senior colleagues Dr. NachGiri. M.S. Dr. S. Shabnam,. M.S., and my junior colleagues Dr. G. Shanthi Kumar, Dr. T. Nageshwar Rao., Dr. S. Madhu., for their help and co-operation. I extend my thanks to superintendent of M.G. Hospital Warangal, for permitting me to utilize the statistical data and case records of this hospital for my study. Special thanks to Anaesthetists, staff nurses, Record section staff, Ward Theatre boys for their co-operation and helpfulness in my study. Finally I am Grateful to all my patients who have co-operated with me for this study.

Dr.K.Raghu

CONTENTS Page No.

PART-I 1.

HISTORY AND INTRODUCTION

1

2.

SURGICAL ANATOMY OF STOMACH

3

AND DUODENUM 3.

GASTRIC PHYSIOLOGY IN RELATION TO

9

PEPTIC ULCER 4.

INCIDENCE

14

5.

ETIOLOGY

16

6.

PATHOLOGY

20

7.

CLINICAL ASPECTS OF DUODENAL ULCER

28

PERFORATION 8.

MANAGEMENT

35

9.

PROGNOSIS

45

PART – II 1.

CASE SHEETS

46

2.

PHOTOGRAPHS

82

PART –III 1.

ANALYSIS OF DATA

86

2.

DISCUSSION

90

3.

CONCLUSIONS

99

4.

BIBILOGRAPHY

102

PART – I

PART – II

PART – III