University:
Stanford University
Course:
MED 101 | Human Anatomy
Academic year:

2023
Views:

160

Pages:

2
Author:

larbi43100

‭Surgical options‬ ‭Without going into details that are beyond the scope of this course, let's just‬ ‭say that the main surgical options are:‬ ‭ ntrectomy with gastroduodenal (Billroth I operation) or gastrojejunal‬ a ‭(Billroth II operation) anastomosis; Truncal vagotomy with antrectomy:‬ ‭-‬ ‭section of the vagus nerve trunks, resection of the antrum and‬ ‭restoration of gastrointestinal continuity. Recurrence is approximately‬ ‭rare; selective vagotomy with pyloroplasty: section of the branches of‬ ‭-‬ ‭the vagus nerves intended for the stomach and pyloroplasty to facilitate‬ ‭gastric drainage. Recurrence is more common; Parietal or supraselective‬ ‭cellular vagotomy: section of the branches of the vagus‬ ‭-‬ ‭nerves intended for the gastric fundus. Recurrence is even more‬ ‭common.‬ ‭ omplications of surgery‬‭-They are potentially numerous:‬ C ‭-‬ ‭ lcerative recurrence: it is more common for UD than for UG. After‬ U ‭partial gastrectomy, it occurs‬ ‭preferably at the anastomosis site;‬ ‭-‬ ‭afferent loop syndrome (only after Billroth II operation): there are two‬ ‭types. Most often, it is caused by a microbial overgrowth in the related‬ ‭stump, and causes abdominal pain, meteorism and diarrhea. More‬ ‭rarely, it is due to incomplete drainage of bile and pancreatic secretions‬ ‭into the afferent loop, and causes abdominal pain, meteorism, nausea‬ ‭and bilious vomiting (20 to 60 minutes after the meal);‬ ‭-‬ ‭ ile reflux gastropathy: it manifests itself as early satiety with pain,‬ b ‭nausea, or vomiting; syndrome of‬‭dumping‬‭:it is characterized‬‭by‬ ‭-‬ ‭vasomotor disorders (palpitations, tachycardia, sweating, orthostatic‬ ‭hypotension) and digestive disorders (nausea, diarrhea) occurring within‬ ‭15 to 30 minutes (‬‭dumping‬‭early), i.e. 1.5 to 3 hours‬‭(‭d ‬ umping‬‭late) after‬ ‭the meal;‬ ‭-‬ ‭ ostvagotomy diarrhea: mainly after truncal vagotomy, some‬ p ‭patients (up to 10%) present with diarrhea 1 to 2 hours after the‬ ‭meal;‬ ‭-‬ ‭anemia: either by iron deficiency (insufficient absorption) after Billroth II‬ ‭type intervention, or by intrinsic factor deficiency (rare in the case of‬ ‭partial gastrectomy), or by blood loss (ulcerative recurrence);‬ ‭-‬ ‭-‬ ‭osteoporosis: common after gastrectomy (total or partial), due to‬ ‭ alabsorption of vitamin D and calcium;‬ m ‭-‬ ‭gastric cancer: the risk increases 15 years‬ ‭after partial gastrectomy.‬ ‭ astroduodenal ulcer disease is common (prevalence of DU > prevalence of‬ G ‭UG) and affects men more than women (especially for DU). Several factors‬ ‭play a role in its appearance: mainly‬‭Helicobacter‬‭pylori‬‭and non-steroidal‬ ‭anti-inflammatory drugs; but also family history and smoking. Clinically, DU‬ ‭is characterized by epigastric pain calmed by food and antacids, most often‬ ‭without vomiting (these two elements‬