4. REC. ULCERATIONโฆ.
๏ SITE
๏ HSV - 1ST PART OF DUODENUM
๏ GJ - AT ANASTOMOSIS ON JEJUNAL SIDE
๏ (JEJUNAL MUCOSA MORE SENSITIVE TO ACID
DIGESTION)
๏ GASTRECTOMY - JEJUNAL SIDE OF THE STOMA
๏ MC PRESENTING SYMPTOM - PAIN
๏ RISK FACTORS
๏ TECHNICALLY INADEQUATE OPERATION
๏ CIGARATE SMOKING
๏ REFRACTORY ULCERS BEFORE OPERATION
5. REC. ULCERATIONโฆ
๏ COMLICATIONS
๏ BLEEDING
๏ PERFORATION
๏ GASTROJEJUNOCOLIC FISTULA
๏ ANASTOMOTIC ULCER PENETRATES INTO TRANSVERSE
COLON
๏ SYMPTOMS
๏ SEVERE DIARRHOEA AFTER EVERY MEAL
๏ FOUL BREATH &MAY VOMIT FORMED FECES
๏ NUTRITIONAL DISTUBANCES(DUE TO SEVERE
CONTAMINATION OF JEJUNUM WITH COLONIC BACTERIA
๏ INVESDTIGATIONS - BARIUM ENEMA,CT SCAN , ENDOSCOPY ,
BARIUM MEAL
๏ TREATEMENT -CORRECTION OF DEHYDRATION & ,
MALNUTRITION,REVISIONAL SURGERY
6. SMALL STOMACH SYNDROME
๏ EARLY SATIETY DUE REDUCTION IN THE SIZE OF
STOMACH
๏ IN HIGHLY SELECTIVE VAGOTOMY -- LOSS OF
RECEPTIVE RELAXATION
๏ IMPOOVES WITH TIME
๏ NO NEED OF REVISIONAL SURGERY
7. BILE VOMITING
๏ AFTER ANY FORM OF VAGOTOMY WITH
DRAINAGE OR GASTRECTOMY
๏ EATING PRECIPITATES PAIN &REFLUX SYMPTOMS
๏ VOMITS A MIXTURE OF FOOD & BILE OR SOME
TIMES BILE ALONE AFTER MEAL
๏ TREATEMENT
๏ REVISIONAL SURGERY
๏ GASTRECTOMY - ROUX-EN Y DIVERSION
๏ GJ โ TAKEN DOWN & SMALL PYLOROPLASTY IS DONE
๏ PYLOROPLASTY โ ANTRECTOMY & ROUX-EN-Y
RECONSTRUCTION
8. EARLY DUMPING
๏ INCIDENCE IN10% OF PTS. FOLLOWING
GASTRECTOMYOR VAGOTOMY&DRAINAGE AND
RARELY FOLLOWING HSV
๏ SYMPTOMS โ ABDOMINAL&VASOMOTOR
๏ MECHANISM
๏ SMALL BOWEL IS FILLED WITH FOOD STUFFS
FROM STOMACH WHICH HAVE HIGH OSMOTIC
LOAD
๏ LEADS TO SEQUESTRATION OF FLUID FROM
CIRCULATION INTO GIT
9. LATE DUMPING
๏ INCIDENCE 5%
๏ REACTIVE HYPOGLYCEMIA
๏ MECHANISM - CARBOHYDRATE LOAD IN
STOMACH CAUSES HYPERGLYCEMIA WHICH
INTURN RISES INSULINLEVELS RESULTING IN
SECONDARY HYPOGLYCEMIA
10. FEATURES OF EARLY&LATE DUMPING
FEATURE EARLY LATE
INCIDENCE 5-10% 5%
RELATION TO MEALS ALMOST IMMEDIATE SECOND HOUR AFTER
MEAL
DURATION 30-40 MIN 30-40 MIN
RELIEF LYING DOWN FOOD
AGGRAVATEDBY MORE FOOD EXCERCISE
PRECIPITATING FOOD ,ESPECIALLY AS EARLY DUMPING
FACTOR CARBOHYDRATE
RICH&WET
MAJOR SYMPTOMS EPIGASTRIC FULLNESS, TREMOUR,FAINTNESS,
SWETTING, PROSTRATION
LIGHTHEADEDNESS,
TACHYCARDIA,COLIC,
SOMETIMES
DIARRHOEA
11. TREATMENT OF DUMPING SYNDROMES
๏ SAME FOR BOTH EARLY & LATE
๏ DIETARY MANIPULATION SMALL DRY
MEALS,AVOID FLUIDS WITH HIGH
CARBOHYDRATE CONTENT
๏ SOMASTATIN ANALOGUE OCTREOTIDE BEFORE
MEALS
๏ REVISIONAL SURGERY
๏ GJ โ DRAINAGE IS TAKEN DOWN
๏ PYLOROPLASTY โ REPAIRGASTRECTOMY -
ANTRERCTOMY&ROUX-EN-Y RECONSTRUCTION