Download CONSEQUENCE OF VARIOUS resection gastrointestinal tract

CONSEQUENCE OF VARIOUS resection gastrointestinal tract resection of the stomach.
When resection fundus department accelerated fluid evacuation in 12 duodenum, while the
mass of solid food but is broken. In total gastrectomy drop many functions of the stomach, as well
as an extensive neuro-humoral effects on other organs of the gastrointestinal tract.
It is known that the stomach has a reflex and regular hormonal influence on the activity of the
liver, pancreas, intestines. Therefore, in gastrectomy hold function disorder of the above bodies.
Particularly large effects gastrectomy associated with the impossibility of acid formation, resulting
in a fall the most powerful pathogen secretion of pancreatic juice, bactericidal effect, the
consequence of which is to change the composition of the microflora of 12 duodenal and jejunal the
development of dysbiosis phenomena. It is in the 12- and jejunum normally contains a small
amount of flora after gastrectomy digestive tract populated these departments pathogens, such as
Escherichia coli, enterococci, the most important consequence of which is enteritis, hepatitis,
diarrhea. In many respects, the latter contributes to the loss of gastric juice curdled effect, why
patients with gastrectomy often observed intolerance to milk.
Proteolytic pepsin slightly offset by the effects of pancreatic trypsin, although secretory
activity of the latter, as well as the liver, is also suffering.
Drops the backup function of the stomach and metered delivery of food in the duodenum 12.
Therefore, the food very quickly gets into the 12th intestine, not having undergone the chemical and
mechanical processing.
In the absence of receipt of a batch of food in 12 duodenum and stimulating effects on the
liver, gall bladder and pancreas, it is impossible to complete the digestion and absorption of food in
the intestines.
Due to the loss of secretion, including gastromukoproteina, disrupted absorption of iron and
vitamin B12 in addition, due to reduced formation of the latter dysbacteriosis colonic microflora.
The result is a violation of hematopoiesis and the development of iron - and even B12-deficiency
anemia. Last secondarily reduces the digestion and absorption in the small intestine. As a result,
loss of the multiple functions of the stomach, as well as the reflex of the endocrine effects of the
latter on the other portions of the gastrointestinal tract in patients with gastrectomy observed
dumping syndrome, reflux esophagitis, an eating disorder, anemia, asthenia agastralnaya.
Dumping syndrome is characterized by unpleasant sensations (nausea, vomiting, pain,
weakness, tachycardia, sensation of heat, sweating, redness of the face) after meals and is associated
with rapid supply (discharge) of food in the intestines.
The basis of the dumping syndrome make a quick passage of food in the 12 th and intestine
reflex influence. This is confirmed by the appearance of dumping syndrome by mechanical
stretching cylinder placed in the jejunum, as well as receiving food usually large Number.
The first experiments on this subject have been carried out in the experimental laboratory ES
London. Removing the cardia of the stomach in dogs led to bulimia and polyphagia. Eating often
ends with vomiting, which resembled a choking and was accompanied by a reduction in the neck
muscles. Features vomiting attributed to the fact that it occurred in the presence of food in the
esophagus (esophageal vomiting).
Turning off the pylorus (the imposition of gastroenterostomy) caused violation of evacuation
of food from the stomach chyme, even more pronounced than at the lower divisions of the small
intestine anastomosis was applied. Removing the fundus of the stomach led to a breach of its
reservoir and secretory functions. Disorders were more pronounced in the complete removal of the
stomach, but its function is gradually taking on the lower divisions of the digestive tract.
After surgical operations such as pyloroplasty, gastrectomy, antrectomia, leading to
dysfunction of the antrum or the pylorus due to rapid evacuation of stomach contents into the
intestine in some patients there is a specific symptom, known as "dumping syndrome". Early
dumping syndrome develops within the first hour after a meal, when there are early satiety,
diarrhea, bloating and abdominal pain. There are also autonomic reactions such as facial flushing,
sweating, tachycardia. These symptoms are associated with the arrival of a large number of
hypertonic chyme from the stomach or a stump in the proximal small bowel. Thus there is a reflex
stimulation of motility, diarrhea, and warrant the sudden increase in the liquid content in the small
intestine, which leads to its stretchability. As a result, possible hypovolemia. Symptoms
exacerbated by the release of gut hormones and vasoactive mediators (bradykinin, serotonin, and
others.) That cause autonomic dysfunction. Late dumping syndrome include dizziness, headache,
tremor, palpitations, sweating, hunger, confusion, and sometimes fainting in 1.5-3 hours after a
meal. Symptoms may appear before, if foods contain large amounts of simple carbohydrates,
especially sucrose. This syndrome is caused by hypoglycemia. First, there is a rapid increase in the
amount of glucose in the blood (hyperglycemia) due to a sharp revenue sugary components of food
from the stomach to the proximal small bowel, which is replaced by hypoglycemia. Rapid
absorption of carbohydrates stimulate the release of insulin, which circulates in the blood longer
than glucose, and eventually develops hypoglycemia.
Reflux esophagitis - an inflammation, often with the formation of erosions and ulcers of the
lower esophagus that occurs due to the absence of the cardiac department, due to the direct
connection of the esophagus with the gut, resulting in thrown at the bile and pancreatic juice into
the esophagus. This is evident sense of heartburn, a burning sensation, pain and even vomiting with
bile, increased salivation.
Agastric asthenia due to persistent malnutrition (loss of appetite, food intake volume,
disorders of digestion and absorption) and is accompanied by muscle weakness and exhaustion of
the nervous system. This leads to a limitation or even complete breakdown of disability in patients
with gastrectomy.
resection 12th intestine. When resection of the proximal part of the 12th intestine is removed
and the main driver of the small intestine rhythm, however, by compensating for the frequency of
intestinal contractions varies slightly.
12 duodenum performs multiple functions due to the presence of direct and feedback to the
hypothalamus, controls the function of the liver, gallbladder, pancreas, small intestine, appetite,
specific - dynamic action of food.
When connecting the stomach to the small intestine (gastroenterostomy) falls regulation
influence 12th guts to portional evacuation of food from the stomach and the conditions for the
casting of intestinal contents into the stomach, and its expression of. Moreover, sharply impaired
digestion and absorption of nutrients due to occurrence of an asynchronous gut bile and pancreatic
juice.
According to A.M. Ugolev, removal of the 12 th intestine accompanied by complex metabolic
disorders in the body, manifesting as muscle atrophy and bone on the background of obesity and
usually incompatible with life.
Jejunal resection eliminates the main site of digestion and absorption, and thus accompanied
by a rapid passage of chyme through the intestines, digestive disorders, fluid and electrolyte
imbalance, diarrhea, weight loss.
The ileum is absorbed the bulk of the fatty acids and vitamin B12. Therefore, it is resected
along with more rapid than in the jejunum resection, the passage of the food will be accompanied
by a deficiency of bile acids and vitamin B12.
Thus, for a state after resection of the small intestine (typically retained proximal segment
length of 20 cm., And the distal 10 cm.) Is characterized by the development of diarrhea and weight
loss. But later comes a partial compensation in the form of extension and expansion of the intestine
left, although diarrhea in some patients remains.
Despite the great importance of large intestine in a water-salt exchange, the condition of
patients after colon resection remains good, which indicates that the body is not essential.