[Verse 1]
Posterior duodenal bleed, scope has failed twice,
Gastroduodenal artery paying a heavy price,
Crack the abdomen, Kocher manoeuvre, mobilise the duodenum clean,
Longitudinal duodenotomy, expose that bleeding scene,
Quadrant sutures — three o'clock, nine, twelve, and six —
Suture-ligate the GDA, that's how you fix,
Then truncal vagotomy, pyloroplasty to drain,
If haemostasis holds and the patient can sustain,
But if the field is hostile, anatomy destroyed,
Antrectomy with Billroth II reconstruction deployed,
Pancreaticoduodenectomy saved for damage control extremes,
Know your options cold — the OR rewards those who scheme
[Chorus]
Posterior bleed — ligate the GDA,
Type II ulcer — antrectomy's the play,
Type IV is high — proximal resection day,
Dumping refractory — convert and reroute the way,
Memorise the pattern, let the anatomy speak,
Surgical curriculum — sharpen every technique
[Verse 2]
Now gastric ulcers, classify them Johnson style,
Type II sits antral-body combo, benign profile,
But acid hypersecretion drives this dual-site disease,
Antrectomy with vagotomy is designed to appease,
Remove the antrum, sever the vagal drive,
Billroth one or two reconstruction, keep the patient alive,
Type IV is the renegade, sitting high and proud,
Near the cardia, lesser curve, malignancy allowed,
Proximal gastrectomy or near-total if you're unsure,
Frozen section margins, do not accept a blur,
Roux-en-Y reconstruction handles the high defect,
Oesophagojejunostomy when total's what you elect
[Chorus]
Posterior bleed — ligate the GDA,
Type II ulcer — antrectomy's the play,
Type IV is high — proximal resection day,
Dumping refractory — convert and reroute the way,
Memorise the pattern, let the anatomy speak,
Surgical curriculum — sharpen every technique
[Verse 3]
Dumping syndrome post Billroth II, patient's not well,
Rapid gastric emptying, osmotic, vasomotor hell,
Early dumping — vasomotor flush within the hour,
Late dumping — reactive hypoglycaemia with sour power,
First line is dietary — small meals, separate solids and fluid,
Acarbose, octreotide, give the gut a chance to be lucid,
Six months conservative, if symptoms persist and grind,
Surgical revision is the answer you will find,
Convert that Billroth II to Roux-en-Y anatomy,
Fifty centimetre Roux limb slows the gastric catastrophe,
Reversed jejunal interposition if Roux fails the test,
Lengthen transit time — that's the operative conquest
[Bridge]
Posterior wall, high on the lesser curve, or dumping post-repair,
Each scenario demands you name the structure, commit, declare,
GDA runs posterior, fundus sits above the fold,
Roux limb tethers emptying — these are facts to hold,
Pattern recognition built through repetition and revision,
Surgical self-assessment sharpened into precision