Page 152 - Medicine and Surgery

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148 Chapter 4: Gastrointestinal system

The side effects of the procedure are operative mortal- Loss of jejunum affects all nutrients, loss of the termi-
ity, ulcer recurrence, dumping syndrome (see later) and nal ileum affects absorption of bile salts and vitamin
diarrhoea. B 12 .Iron and folate are absorbed from the upper small
Partial gastrectomy is usual (total gastrectomy is un- bowel.
common): Severe diarrhoea causes electrolyte loss, hypertrophy
Bilroth I in which the distal part of the stomach is of the mucosa occurs over a period of 2 years after

removed and the stomach remnant connected to the whichanyresidualdiarrhoeaislikelytobepermanent.
duodenum. Following small bowel surgery fluid and electrolytes
Bilroth II differs in that the stomach remnant is con- mustbemonitoredandcorrectedasrequired,fat-soluble

nected to the first loop of the jejunum and the duode- vitamins should be supplemented.
nal stump is closed.
Complications following surgery: Large bowel surgery
Duodeno-gastric reflux, may lead to chronic gastritis.

Vomiting due to stoma narrowing. Resection of the large bowel often requires temporary or

Recurrenceoftheoriginaldisease(gastriculcer,gastric permanent stoma to allow healing of the relatively frag-

carcinoma). ile bowel. Patients require counselling wherever possible
Nutritionalconsequencesincludeweightloss,ironde- prior to surgery.

ficiency anaemia, vitamin B 12 deficiency and malab- Astoma refers to the exteriorisation of any part of the
sorption. bowel. These are subdivided into two categories:
The dumping syndrome is due to the uncontrolled 1 Colostomy (exteriorisation of the colon), which is

rapid emptying of hyperosmolar solution into the flush to the skin. Both ends may be exteriorised as
small bowel characterised by a feeling of epigastric acolostomy and a mucous fistula or the rectal stump
fullness after food associated with flushing, sweating can be closed off and left within the pelvis (Hartman’s
15–30 minutes after eating. This syndrome may im- procedure). Both procedures may be reversible.
prove with regular small frequent meals. Surgical re- 2 Ileostomy, which requires the creation of a cuff of
vision may be indicated. bowel to prevent skin damage as a result of the di-
Reactive hypoglycaemia is due to rapid absorption of gestive enzymes.

glucose from the upper small bowel, causing a reactive In elective procedures such as resection of tumours
hyperinsulinaemic state and then hypoglycaemia. bowel preparation is performed to clear the bowel of
Small increased risk of gastric cancer following partial faeces prior to surgery. Prior to emergency surgery ag-

gastrectomy after a latent period of 20 years possibly gressive resuscitation is required. Resection of tumours,
due to bacterial overgrowth with the generation of when of curative intent, involves removal of an adequate
carcinogenic nitrosamines from nitrates in food. region of healthy bowel and as much as possible of the
regional lymph drainage.
Complications of intestinal surgery include wound
Small bowel surgery
infection (see page 16) and anastomotic failure, the
Smallbowelresectionisnormallyfollowedbyimmediate treatment for which is surgical drainage and exteriori-
end-to-end anastomosis as the small bowel has a plen- sation.
tiful blood supply, a stronger wall and a content with a
lower bacterial count. Small to medium resections have
little functional consequence as there is a relative func- Gastrointestinal infections
tional reserve; however, massive resections may result in
malabsorption. Food poisoning
Gastrichypersecretioniscommonpost-resectionpos-

sibly due to loss of secretary inhibitory factors. Definition
Nutritional consequences are severe when more than Bacterial food poisoning is common and can be caused

75% of the bowel is resected. by anumber of different organisms.