post gastrectomy syndromes Flashcards
What is retained antrum syndrome?
retained astral tissue within duodenal stump after gastric resection
how does retained antrum syndrome work
G cells bathed in alkaline fluid then continuous gastrin release then increased acid production in proximal stomach remnant and ulceration
what should you remember to do if suspecting retained antrum syndrome?
check gastrin level to rule out gastrinoma
what is early dumping syndrome
20-30 min after meal - occurs d/t abrupt hyperosmolar load to small intestine
get tachycardia, diaphoresis, dizziness, flushing
what is late dumping syndrome?
1-4 hours after a meal
due to rapid carb load to small intestine resulting in large insulin surge and rebound hypoglycemia
how is dumping syndrome managed?
small meals, no sugary drinks, octrotide if refractory to dietary changes
what is alkaline reflux gastritis?
After B1 or B2 reconstruction
Feels like GERD
How do you diagnose alkaline reflux gastritis?
impedance studies
what is the medical management of alkaline reflux gastritis?
pro kinetic agents, bile acid binding resins
what is the surgical management of alkaline reflux gastritis
conversion to RNY with at least 50 cm roux limb to avoid recurrent bile reflux
what is aBraun enterostomy?
anastomosis between afferent and efferent limb
what is afferent limb syndrome?
acute or chronic obstruction of afferent jejunal limb after B2 reconstruction
how does afferent limb syndrome work
increased luminal pressure of afferent limb can result in obstructive jaundice, cholangitis, pancreatitis from back pressure in biliopancreatic system, duodenal stump blowout, bacterial overgrowth
what does bacterial overgrowth do in afferent limb syndrome
bacteria deconjugate bile acids leading to steatorrhea, malnutrition, and vitamin B12 deficiency leading to megaloblastic anemia
how do you treat afferent limb syndrome?
convert to RNY or B1
bacterial overgrowth can be managed first with abx (high relapse rate)
