GI Section 1: Luminal (UPPER GI Surg Complications) Flashcards
A potential complication post billroth 2 (Roux-en-Y and also Whipple / partial pancreaticoduodenectomy).
Afferent Loop Syndrome
Something extrinsic or intrinsic obstructs the upstream/afferent limb causing secretions, bile, and pancreatic juice to build up
extrinsic (adhesions, internal
hernia, neoplasm)
intrinsic (scarring from radiation, edema from a marginal ulcer)
Afferent loops syndrome
Belly pain + bilious vomiting (depending on the level of obstruction) after billroth 2 (Roux-en-Y and also Whipple / partial pancreaticoduodenectomy)
Afferent Loop Syndrome
fluid filled “U-shaped” loop of bowel adjacent to the pancreas.
Afferent loops syndrome
common bile duct entering the loop + dilated bile ducts
the pressure from all this back up dilates the gallbladder, and can cause pancreatitis.
Afferent limb syndrome
This is a group of symptoms; diarrhea, nausea, feeling light- headed / tired after a meal
- CAUSED by rapid gastric emptying (after Billroth 2 and early post op after Rouex-en Y)
This type of dumping is related to rapid transit of undigested food from the stomach
Dumping syndrome
The therapy is typically conversion of Billroth to Roux-en-Y (and avoiding delicious carbs).
With regard to these old peptic ulcer surgeries (Billroths), there is a 3-6 times increased risk of getting this in the gastric remnant (like 15 years after the surgery).
Gastric CA, especially adenoCA
Fold thickening and filling defects seen in the stomach after Billroth I or II
Bile Reflux Gastritis
This is a rare complication in which the jejunum herniates back into the stomach (usually the efferent limb) and can cause gastric obstruction. High mortality is present with the acute form.
Jejunogastric Intussusception
Best ways to look for leaks
water soluble oral contrast exam in Fluoro 1-2 days post op - either supine or supine left posterior oblique (75% of leaks will drain to the left)
the single most reliable sign of perforation.
There is a paper that says a heart rate > 120
This is seen in Roux-en-Y patients with the classic history of weight gain years after the surgery
Gastro-Gastric Fistula
the fistula allows them to double up on the bacon cheeseburgers without any discomfort
The anastomotic breakdown is usually a chronic process, and often is not painful.
Ulcers at or near the anastomosis of the stomach and the jejunum (gastrojejunal)
Marginal Ulcer
Most common location of marginal ulcers:
G-J anatsomosis
These things occur because the small bowel is not used to getting exposed to stomach acid - it don’t like it.
They are typically solitary and variable in size.
Marginal ulcers are classically solitary. If there are multiple giant (2.5 cm or larger) ulcers in this same region - you think of?
Chronic Jejunal atresia
Two types of obstruction
The CAUSES, OUTCOMES and TREATMENTS are DIFFERENT!
Explain Simple mechanical obstruction
This is why (a) vou see air fluid levels in simple mechanical obstruction, and (b) the therapy centers around decompression of these additional secretions through the use of NG tubes.
Small bowel twists and creates a closed loop, there are often two components:
a. The closed loop - distends quickly from secretiona nd venous stasis (No gass unless its the colon)
b. The supralesional componen - distends slower than the closed (incarcerated) componet - may have air-fluid levels
Severe cases of closed loop have how many transition point?
ou may not see the upstream “supralesional” component - it hasn’t had time to develop before the patient presents to the CT scanner.
have faster progression in ischemic symtpoms
Classic morphology of Closed loop obstruction
3 Beak sign
If the twisted segment is long, you may see vessels and loops converge towards a central point.
Radial layout
C or U Shaped Fluid Filled Distended Loop are best seen on?
the coronal view
There are three primary types of SBO described after Roux-en-Y based on their location.
