[Verse 1]
H. pylori burrowing through the gastric mucin shield
NSAIDs strip the prostaglandins, damage unrevealed
Zollinger-Ellison — gastrinoma, acid overload
Stress ulceration in the ICU when organs erode
Triple therapy: PPI plus clarithromycin and amoxicillin
Two weeks of eradication, watch the colonisation thinning
Bismuth quadruple when resistance rears its complicated head
Test and treat with urea breath — confirm the bug is dead
[Chorus]
Magengeschwür — das Blut, die Narbe, der Schmerz
Perforation, obstruction hitting like a curse
Ulcère peptique — soigne ou opère
Forrest class one A, endoscope first, be prepared
Bleeding, perforation, obstruction, intractability —
Four complications, carve them deep in your memory
[Verse 2]
Forrest one A — spurting vessel, highest rebleeding fear
Epinephrine plus thermal coagulation, haemostasis clear
One B oozing, two A visible — clip or cauterise the site
Two B clot adherent, two C flat spot — lower risk tonight
Angioembolization when endoscopy has failed
Surgical oversew — ligate the gastroduodenal, unveiled
Pringle the duodenum, open the pylorus wide
Undersew the bleeder from the posterior inside
[Chorus]
Magengeschwür — das Blut, die Narbe, der Schmerz
Perforation, obstruction hitting like a curse
Ulcère peptique — soigne ou opère
Forrest class one A, endoscope first, be prepared
Bleeding, perforation, obstruction, intractability —
Four complications, carve them deep in your memory
[Verse 3]
Perforation — Graham patch, omentum plugging up the breach
Laparoscopic sealed if the peritonitis stays in reach
Non-operative: Boey score zero, pneumo walling off contained
Definitive acid surgery only if H. pylori explained
Gastric outlet obstruction — pylorus scarred and tight
Endoscopic balloon dilation as the opening fight
Gastrojejunostomy bypasses the blockade at the gate
Antrectomy for recalcitrant, when dilation's come too late
[Bridge]
Modified Johnson — cinq types to classify
Type one: lesser curve, antrectomy apply
Type two and three: duodenal component entwined
Vagotomy-antrectomy, leave no acid behind
Type four: high lesser curve — gastric resection, Roux drain
Type five: NSAID-induced anywhere — stop the culprit's reign
Now vagotomy's taxonomy — a verisimilitudinous maze:
Truncal cuts the vagi whole, needs drainage always
Heineke-Mikulicz — longitudinal to transverse pyloroplasty
Finney's wider, Jaboulay bypasses the pylorus vastly
Selective spares the hepatic branch, highly selective's parietal art
Lowest recurrence but the highest technical demand on your part
[Chorus]
Magengeschwür — das Blut, die Narbe, der Schmerz
Perforation, obstruction hitting like a curse
Ulcère peptique — soigne ou opère
Forrest class one A, endoscope first, be prepared
Bleeding, perforation, obstruction, intractability —
Four complications, carve them deep in your memory