gastric surgery complications Flashcards
What are the late complications of gastric bypass surgery?
Small bowel obstruction (adhesions, internal hernias, volvulus).
Anastomotic strictures.
Marginal ulcers.
Nutritional deficiencies (e.g., vitamin B12, iron).
What clinical features suggest small bowel obstruction (SBO)?
Severe, crampy abdominal pain.
Nausea and vomiting (bilious if obstruction is distal).
Abdominal distension.
Absence of flatus or bowel movements.
What imaging study is most useful in diagnosing SBO?
Abdominal CT scan: Helps identify the obstruction site, severity, and complications (e.g., strangulation, herniation).
Why is bilious vomiting significant in small bowel obstruction?
It indicates that the obstruction is distal to the ampulla of Vater, as bile from the common bile duct can enter the proximal small bowel.
What is the most common cause of small bowel obstruction in patients with a history of abdominal surgery?
Scar tissue from prior surgeries can create adhesions producing a mechanical obstruction.
How do internal hernias cause small bowel obstruction after gastric bypass?
Altered anatomy allows bowel loops to become trapped in abnormal spaces, leading to obstruction and ischemia.
A patient who had an abdominal surgery in the recent past, now presents with watery diarrhea, bloating, flatulence, and abdominal pain, what is the likely cause?
SIBO (Small Intestinal Bacterial Overgrowth)
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Overgrowth of colonic bacteria in the SI, resulting in enterocyte damage and malabsorption.
A 57-year-old man comes to the physician because of a 3-month history of five to six loose stools daily and a 7.3-kg (16-lb) weight loss. He notes that he had two to three bowel movements daily for 3 weeks following a 10-day course of tetracycline 2 months ago. He underwent antrectomy with Billroth II reconstruction for a perforated gastric ulcer 1 year ago. He has not had any changes in his diet. He has osteoarthritis of the hips treated with ibuprofen. He is 185 cm (6 ft 1 in) tall and weighs 72 kg (160 lb); BMI is 21. Examination shows excess skin folds over the abdomen. The abdomen is scaphoid with a well-healed surgical scar. Which of the following is the most likely cause of this patient’s diarrhea?
Bacterial overgrowth results from abnormal growth of bacteria in the small intestine, which disrupts normal digestion of macromolecules. Patients present with recurrent nausea, vomiting, abdominal pain, bloating, weight loss, loose stools, and vitamin and mineral deficiencies. Bacterial overgrowth classically occurs in patients with previous history of abdominal surgeries, resection of the ileocecal valve, creation of blind loops, or following prolonged use of proton pump inhibitors. This is caused by the loss of normal intestinal peristalsis, retrograde translocation, or disruption of acidic pH as means of limiting bacterial presence or promoting bacterial elimination in the small bowel. The increased metabolism from bacteria, their colonization of the bowel wall, and disruption of normal gut flora contribute to malabsorption and resultant symptoms. Bacterial overgrowth occurs more frequently in patients with blind or limited-transit intestinal loops created during procedures such as the Billroth II or Roux-en-Y gastric bypass, resulting from the loss of passing food bolus which allows for appropriate anterograde propulsion of bacteria along the gastrointestinal tract. Patients may see improvement in symptoms following administration of antibiotics, which decreases bacterial burden.
