COMPLICATIONS OF GASTRIC SURGERY Flashcards
What are the possible complications of gastric surgery?
Recurrent ulceration Afferent loop syndrome Dumping syndrome Diarrhoea Anaemia Malabsorption Carcinoma
Why are people who have had a partial gastrectomy more at risk of recurrent ulceration?
Continued acid production without vagotomy
What is afferent loop syndrome?
A mechanical partial or complete obstruction of the afferent loop (duodenum supplying enzymes and bile) post gastric surgery. This resulting in incomplete drainage of bile and pancreatic secretions. Most commonly associated with Billroth II distal subtotal gastrectomy. Complete obstruction is a surgical emergency.
How do people with afferent loop syndrome present?
Abdominal pain up to 1 hour after meals
Distension
Nausea
Vomiting - which relieves symptoms somewhat
How do you treat afferent loop syndrome?
Surgical revision of the loop
What is dumping syndrome?
Complication of gastric surgery. Ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested. It happens when the small intestine expands too quickly due to the presence of hyperosmolar contents in the stomach. It is a vasovagal response.
Late dumping seems also to be related to hypoglycaemia as a result of excessive insulin release.
What are the two types of dumping syndrome?
Early dumping - occurs within 30 minutes after a meal
Late dumping - occurs between 90 minutes and 3 hours after a meal
What are the clinical features of early dumping syndrome?
Palpitations Light headedness Postural hypotension Abdominal discomfort Hypokalaemia
What are the clinical features of late dumping syndrome?
Lightheadedness Palpitations Sweating Postural hypotension Syncope Hypokalaemia
How do you manage someone with dumping syndrome post gastric surgery?
Dietary advice - small frequent meals
If very severe can use somatostatin analogue.
