Diseases of the operated stomach

Diseases of the operated stomach develop as a result of surgical intervention, as the anatomical and physiological interaction of the digestive tract significantly changes and the neurohumoral function is disrupted,that affects the body as a whole.

In other words, it's iatrogenic diseases. Depending on the operation performed, post-gastrectomy or postvagotomy disorders may occur, so the doctor must know exactly which operation was performed to the patient.

Possible complications of

Several decades ago, selective proximal vagotomy was used to eliminate peptic ulcer. Today, there are medicines that can reduce the severity of the disease and reduce the number of relapses, so patients with uncomplicated ulcers are treated conservatively. Vagotomy is used only for the surgical treatment of some complicated ulcers.

Today's doctors are much more likely to deal with post-gastrectomy disorders. In 30-35% of people after removal of part of the stomach and 15-35% after vagotomy, clinically significant functional and morphological disturbances are observed.

According to statistics, people who have been operated because of stomach ulcers are more often diagnosed with dumping syndromes and open sarcoid ulcers, and those that were operated because of a stomach tumor often suffer from post-gastrectomy anemia or dystrophy.

It is possible to assume the development of complications based on the nature of the operation and its causes, and also taking into account other diseases of the digestive system that worsen the compensatory function.

Depends whether complications arise from the development of gastrointestinal hormones that regulate secretory function, absorption, motor, blood supply of the gastrointestinal tract and its trophic processes, as well as from heredity and external factors influencing adaptation( harmful habits, taste preferences).

There are several classifications of diseases. Depending on the type of intervention disorders are divided into 2 types:

• postgastorezektsionnye .This includes dumping and hypoglycemic syndrome, open ankle sores, hinge-causing syndrome, dystrophy and anemia;
• post-production .Include dysphagia, gastrostasis, relapse of ulcers, diarrhea, dumping syndrome.

Diagnosis is made after the examination of the symptoms of the disease, and also based on the results of X-ray and endoscopy, laboratory data

Characteristics of the abnormalities of the operated stomach

Normally, food from the stomach gradually enters the small intestine in small portions and for several hours, while it is diluted immediately with digestive juices. After the operation, a violation of this process is possible, which leads to stagnation of the contents of the stomach or, conversely, to its accelerated evacuation.

After the operation, other concomitant diseases may progress, for example, cholecystitis, pancreatitis, enterocolitis, hepatitis. Reflux gastritis or reflux esophagitis may develop.

Dumping syndrome

This pathology occurs much more often than other complications. With dumping syndrome there is an accelerated discharge of food from the stomach and rapid passage of the food lump through the small intestine. As a result, the osmotic pressure rises and fluid enters the lumen of the intestine.

Accelerated absorption of carbohydrates causes synthesis of insulin more than is required. Negative effects on the body and excessive production of biologically active substances and hormones.

Symptoms of dumping syndrome:

• weakness;
• increased sweating;
• heart palpitations and increased blood pressure;
• pallor or redness of the skin;
• drowsiness;
• dizziness;
• possible fainting;
• heaviness and rumbling in the abdomen;
• diarrhea;
• nausea, vomiting;
• outlet of gas from the stomach or esophagus.

Depending on the severity of the symptoms, there are 3 degrees of the disease. With a mild form of the disorder, seizures are not very pronounced and appear periodically, often after eating some products, last for long.

At moderate severity, the clinic manifests itself after eating any products, it is more pronounced and lasting. Working capacity decreases, the patient has to rest after eating. With a severe degree of the disease, the symptomatology is pronounced, the working capacity decreases so much that the patient receives a disability.

The diagnosis does not cause difficulties for the doctor. With X-ray diagnosis, rapid evacuation of food from the stomach and its accelerated passage through the intestine are observed. Also, the diagnosis is confirmed by a characteristic glycemic curve, which is measured after the carbohydrate load.

Hypoglycemic syndrome

The disorder is called a late dumping syndrome. Often, these diseases are manifested in a duet, but can develop separately. Hypoglycemic syndrome is diagnosed in 5-10% of operated.

After accelerated passage of the stomach, the food is in the small intestine, and along with it, carbohydrates enter. Immediately there is a lot of glucose in the blood and the pancreas releases a large dose of insulin, which leads to a decrease in the concentration of sugar and the formation of hypoglycemia.

In case of an attack, patients experience severe hunger, painful abdominal cramps, weakness, sweating, a feeling of heat, a feeling that the earth is running out from under your feet, palpitations, trembling in the body, darkening in the eyes, loss of consciousness is possible. Symptoms occur 2-3 hours after meals and last from two minutes to two hours.

After the operation, the entire digestive tract

changes. After eating a carbohydrate patient, the glycemic curve is characterized by a sharp rise and the same rapid decline in sugar concentration. The sugar level is lower than it was.

Syndrome of the leading loop

In this pathology, the excretion of the contents of the duodenum is violated and some part of the food enters the leading loop of the small intestine. There are functional syndrome, which develops due to a decrease in intestinal motility, and mechanical, which is due to some obstacle, for example, loop bending or soldering.

In this syndrome, patients experience pain under the ribs on the right, which appears after a while after the meal and subsides after severe vomiting( in the vomit, bile is present).Frequent vomiting provokes loss of electrolytes, worsening digestion, weight loss.

Diagnosis is based on X-ray diagnostic data. The specialist ascertains stopping the contrast agent in the leading loop and changing its motor function. Sometimes in the epigastric region, the doctor may feel at the palpation that the loop is stretched, it passes after strong vomiting.

Post-resection asthenia

It is formed due to a malfunction of the stomach, liver, small intestine, pancreas. The cause of pathology in the small capacity of the stomach and accelerated food release, as well as in the decrease in the production of hydrochloric acid and pepsin. In the case of a disorder, the patient experiences weight loss, iron deficiency, and bone fragility.

Peptic ulcers

May appear after a year or even eight years after the operation. Clinic disease is similar to manifestations of peptic ulcer, but the symptoms are more pronounced. Often, bleeding occurs and the spread of ulcerative lesions to neighboring organs. X-ray and endoscopic examination will confirm the formation of peptic ulcer.

Post-gastrectomy degeneration

The disorder is noted in 3-10% of cases. The disease develops as a result of a violation of digestive function and absorption, this is due to insufficient secretion of pancreatic juice and changes in the small intestine. In the formulation of the diagnosis, the main role is played by the clinic of the disease. The patient notes rumbling and flatulence, diarrhea.

There are signs of impaired absorption( weight loss, lack of vitamins, a sudden contraction of gastrocnemius muscles, breaking bones).With pathology, liver and pancreatic dysfunction can occur, mental disorders( hypochondria, hysteria, depression) are noted.

Postgastrectomy anemia

Occurs in 10-15% of operated patients. Iron deficiency anemia or a deficiency of cobalamin may develop. Iron deficiency anemia occurs due to latent bleeding from ulcers or erosions. Anemia of this species develops and because of the violation of ionization and absorption of iron because the intestinal mucosa is inflamed.

After surgical intervention, synthesis is broken and the intestinal microflora changes, and this significantly reduces the utilization of cobalamin and folic acid. The lack of these vitamins causes megaloblastic hematopoiesis and anemia.

Disease of the operated stomach is caused not only by incorrect choice of operation, but also refusal of patients to follow the recommendations of the doctor

Dysphagia

Appears a few weeks after the operation and disappears without medical treatment after 1-2 months. Occurs because of an injury and edema of the esophagus. Among the causes and temporary dysfunction of the cardia. The development of the disorder through a longer time period is associated with the scar in the dissection area and with reflux esophagitis. The diagnosis is confirmed with the help of radiology and endoscopy.

Gastrostasis

The disorder occurs as a result of delayed emptying of the intestine. It appears due to occlusion of the gastric outlet( mechanical gastrostasis) or abnormal rhythm of the contractions of the stomach, which provokes a strong stretching of its walls( functional gastrostasis).

In pathology, the patient feels an overflow in the epigastric region, nausea, temporary pain. In severe forms of the disease, pain is constantly present, there is a strong vomiting of stagnant contents of the stomach. Vomiting relieves symptoms, so patients often cause it specifically.

Relapses of ulcers

The cause of recurrence of ulcers is a slightly reduced denervation of the stomach and no diminishing production of hydrochloric acid. Often relapses of ulcers occur without a pronounced symptomatology, so patients who have undergone vagotomy are asked to undergo a survey twice a year for five years.

Diarrhea

In patients, diarrhea after vagatomy occurs frequently. At a pathology too quickly there is an evacuation of a liquid in an intestine. This is due to changes in the microflora of the intestine, a violation of the production and absorption of bile acids, mucosal atrophy, worsening of the pancreas.

The disease manifests itself as diarrhea, which is repeated 3-5 times a day, and it occurs very unexpectedly, accompanied by increased gas formation and rumbling. Diarrhea is observed for several days, similar is repeated twice a month.

How to prevent the development of complications and what treatment is required

When preparing for the forthcoming operation, the patient is prescribed to undergo antiulcer therapy, and oncology, general restorative measures and elimination of symptoms are performed. After the operation, hunger is prescribed for two days.

To prevent the development of a complication after the operation of the stomach is possible with the correct choice of the method of operation and a well thought-out rehabilitation program

Then, in the absence of symptoms of food stagnation in the stomach, the patient must follow the recommended diet. The load on the stomach increases gradually. If the synthesis of hydrochloric acid is not reduced, then antacids are appointed. The diet is recommended rubbed( P), it limits the mechanical and chemical irritation of the stomach.

For 2-5 years after surgery, the patient should exclude easily digestible carbohydrates and fresh milk from the diet. If the operation was successful, no medication is required.

Treatment of complications is possible by a surgical or conservative route. An important component of treatment is diet. Food should contain a large amount of protein, a normal amount of fat and complex carbohydrates, you need to remove simple carbohydrates from the menu.

Medications are prescribed depending on the cause of the disease. So, to improve the discharge of stomach contents into the intestine prokinetics are recommended, to remove inflammation in the blind loop, antimicrobial therapy is performed, with severe hypoglycemia, a glucose solution is intravenously injected.

Most of the diseases of the operated stomach develop after a short period of time and subside within a year. Patients should carefully monitor their own well-being and inform the attending physician about the slightest digestion disorders, so that timely medical or dietary correction is carried out. From dispensary registration, patients are removed after three years of absence of signs of development of diseases of the operated stomach.