Month: September 2019

Dumping syndrome is a condition characterized by the occurrence of severe weakness, dizziness, palpitations, a feeling of heat 10-15 minutes after a meal and is regarded as a reaction of the body’s adaptation to altered digestion processes.

Etiology, pathogenesis of dumping syndrome

The trigger mechanism of dumping syndrome is the accelerated intake of insufficiently processed, concentrated food, mainly easily digestible carbohydrates, from the stomach into the jejunum . Dumping syndrome occurs, as a rule, in patients after surgery on the stomach. Moreover, its severity depends on the nature of the operation. When the duodenum is switched off from the passage, the manifestations of dumping syndrome are more pronounced, but they can also be detected in unoperated patients. Neuromuscular mechanisms are involved in the occurrence and development of dumping syndrome, accompanied by redistribution of blood with an increase in its flow to the digestive canal organs and a violation of the central hemodynamics. In addition, to normalize the processes of absorption and create an isotonic environment, a significant amount of fluid enters the small intestine, which leads to hypovolemia. In dumping syndrome, there are a number of disorders of the digestive function of the stomach, small intestine, liver, and pancreas, due to their functional state and transferred surgical intervention.

Clinic of dumping syndrome

The clinic of dumping syndrome is very characteristic and manifests itself 10-15 minutes after eating. Clinical manifestations begin with a feeling of fullness in the epigastric region and are accompanied by an unpleasant feeling of heat in the upper half of the body or throughout the body. The perspiration sharply amplifies. Then come weakness, drowsiness, dizziness. In some cases, these phenomena reach such strength that the patient is forced to lie down. Attacks are accompanied by tachycardia, sometimes shortness of breath, headache, paresthesia in the upper and lower extremities, vasomotor rhinitis, polyuria. Dyspeptic phenomena during an attack are diverse: salivation, dry mouth, heartburn, belching. Very often there is rumbling in the abdomen, diarrhea at the end of the attack or some time after it. The intensity of the attacks can vary.
In a horizontal position, the general condition of the patient improves, which causes severe manifestations of dumping syndrome to take food in bed and lie for some time after eating. Dumping syndrome is most often triggered by dairy and carbohydrate foods.
Depending on the severity of clinical manifestations, there are 3 degrees of severity of the disease: I ( mild ) degree is characterized by periodically occurring short (15-20 minutes) seizures after ingestion of milk and carbohydrate foods. During an attack, the heart rate increases by 10-15 in 1 min, blood pressure can increase or decrease by 10-15 mm Hg . (1.3-2 kPa). The deficit of body weight does not exceed 5 kg. Performance saved. Drug treatment and the exclusion of foods that cause dumping syndrome from the diet gives a good effect. II ( moderate severity ) degree is characterized by attacks of weakness that constantly occur after eating, dizziness, pain in the heart, sweating, and diarrhea. The duration of attacks is 20-40 minutes with any nature of the food. During an attack, the pulse increases by 20-30 in 1 min, blood pressure rises by 15-20 mm Hg . (2-2.7 kPa). The deficit of body weight is 5-10 kg. Performance reduced. Conservative therapy “gives short-term effect. III of ( severe ) degree – persistent, pronounced attacks with kollaptoid – nym . Condition, diarrhea, do not depend on the nature and quantity of food intake, lasting about 1 hour during the attack on the pulse quickens 20-30 1 min, blood pressure decreases by 20-30 mm Hg (2.7-4 kPa). Weight deficit exceeds 10 kg. Patients are not able to work. Treatment is ineffective.

Forecast and workability of dumping syndrome

With a mild degree of severity of the dumping syndrome, the working capacity is not impaired, with an average – reduced, and with a severe one – patients are not able to work.

Expansion of the stomach is acute – a sudden abrupt increase in the stomach due to the accumulation of fluid and gas in it.

Etiology and pathogenesis of acute expansion of the stomach

The basis of this rare disease is paralysis of the neuromuscular apparatus of the stomach, manifested by atony of the wall of the stomach while maintaining its secretory activity. In the pathogenesis of the disease, a significant role is given to disturbances in the water-electrolyte balance and CBS. The pathology is rare, it can occur in diseases such as myocardial infarction, peritonitis, pneumonia, gastric vascular thrombosis, prolonged pyloric stenosis

Clinic for acute expansion of the stomach

Acute enlargement of the stomach is manifested by signs of obstruction of the stomach. The leading clinical symptoms are abdominal heaviness, nausea, vomiting, heartburn. In some cases, spilled abdominal pain is disturbing.
When examining a patient, a significant, rapidly increasing protrusion in the epigastric region, a wide zone of tympanitis extending beyond the center line to the left, tachycardia, and a drop in cardiac activity are determined. Symptoms quickly increase, there are fears of complications (violation of the blood supply to the stomach wall, rupture of it) due to compression of the heart.

Diagnosis of acute gastric expansion

Along with the clinical manifestations of the disease is extremely important yavdlyaetsya X-ray examination in which reveal the high standing of the left dome of the diaphragm, a sharp increase in volume, with a lot of liquid and gas bubble stomach. When examining a patient in an upright position in the stomach, two horizontal fluid levels can be detected due to an excess of the stomach on the ligamentous apparatus. The radiological symptoms of the absence of peristalsis of the gastric wall with a long delay in the evacuation of barium suspension from the stomach are important.

Adjacent loop syndrome is a pathological condition that develops after Billroth- II stomach resection , manifested by a feeling of heaviness in the right hypochondrium and vomiting of bile after eating. The frequency of this syndrome, according to various authors, ranges from 0.8 to 51.9%.

Etiology, pathogenesis of afferent loop syndrome

Acute syndrome of the leading loop develops with complete obstruction and, as a rule, in the early postoperative period. The reasons are most often various mechanical factors and only sometimes the atony of the afferent loop. Chronic afferent loop syndrome is most often the result of functional disorders – duodenal hypotension, its dyskinesia, anastomosis spasm and abduction loop. With peptic ulcer of gastro – enteroanastomosis , when the ulcerative infiltrate compresses the outlet loop, a secondary chronic syndrome of the leading loop of a mechanical nature may develop. Kinks and adhesions in the area of ​​the anastomosis can lead to it.

Clinical Loop Syndrome Clinic

With a mild severity of the syndrome, rare spitting up or mild vomiting of bile is observed 15 minutes to 2.5 hours after eating. Patients often do not attach any importance to these phenomena, the ability to work is preserved. The syndrome of moderate severity is manifested by bursting, quite intense pain in the right hypochondrium after eating and vomiting of bile, which occurs quite often, as well as a decrease in body weight and a significant decrease in working capacity. The severe severity of the afferent loop syndrome is characterized by profuse vomiting of bile after each meal. Vomiting is usually preceded by excruciating pain in the right hypochondrium and epigastric region. Patients are exhausted, their ability to work is reduced. In most patients , the afferent loop syndrome develops in the 1st year after surgery, and in some, even within the 1st month.

Diagnosis of the afferent loop syndrome

Diagnosis of the afferent loop syndrome should be based primarily on the clinical picture. The X-ray method of research, which primarily reveals organic pathology and some functional changes in the stomach stump, leading and removing loops, the anastomotic region, has a certain significance in recognizing the syndrome. Refluxing the contrast medium into the lead loop (reflux) cannot be a reliable sign of the lead loop syndrome, since it occurs only in 20-30% of patients with clear clinical signs of this syndrome.

Functional disorders of the stomach are manifested by a violation of its individual functions, a change in the position and tone of the stomach. The causes of the disorder of certain functions of the stomach may be nutritional, nervous or humoral factors.
A violation of the secretory function of the stomach can not always be regarded as a disease. This function, like other functions of the stomach, is subject to known fluctuations depending on the state of the neuro-glandular apparatus of the stomach and regulatory mechanisms. Violations of the secretory function of the stomach include hypersecretion and hyposocretion . In clinical practice, the principle of differentiation of the secretory function of the glandular apparatus of the stomach according to the level of free hydrochloric acid has been established.
The principles of constructing dietary treatment for patients suffering from hypersecretion and increased acidity of gastric juice are based on creating rest for an “irritated stomach” by maximizing mechanical, chemical and thermal sparing of its mucous membrane. Showing foods and dishes related to weak pathogens of secretion and quickly leaving the stomach, depending on the consistency of the poor. Liquid and mushy beggars evacuate from the stomach faster than solid.
Spicy snacks, fried foods, extractive substances, meat, fish, vegetables, mushrooms, spices, savory snacks, canned food, coffee, alcohol, spices, marinades, carbonated drinks, and ice cream are prohibited.

General characteristics of the diet

The diet is mixed, physiologically complete, with a normal content of proteins, fats and carbohydrates. Food is given in liquid and mushy form with the restriction of dishes containing many cell walls.
Culinary processing. All dishes are cooked boiled or steamed, mashed. The chemical composition and calorie content. Proteins 100-110 g (at least 60% of animal origin), fats 100 g (of which 1/3 are vegetable), carbohydrates 400-450 g. Calories 3000-3200 kcal. The amount of free fluid is 1.5 liters. Salt – 12 g. The mass of the daily diet is about 3 kg. Fractional diet (5-6 times a day). A list of recommended foods and dishes. Bread and bakery products. Yesterday’s or dried wheat bread, as well as crackers. Soups Cereals, dairy, mashed. Meat and fish dishes. Meat of low-fat varieties (beef, veal, chicken) in boiled or steam form, mashed (cutlets, dumplings, meatballs, soufflé, roll, etc.). Non-rigid and lean meat is allowed in a boiled form with a piece. Low-fat (mainly river) fish, boiled or steam in pureed form and a piece. Dishes and side dishes from vegetables. Potatoes, carrots and beets boiled in water, in mashed form. Dishes and side dishes from cereals and pasta. Porridges and puddings semolina, rice, buckwheat and oatmeal crouy , boiled vermicelli, melkonarublennye pasta. Dishes from eggs. Soft-boiled eggs, steam omelet. Fruits, berries, sweet foods and sweets. Sweet varieties of berries and fruits, sugar, honey. Stewed fruit compotes, baked apples, jelly, mousse, jelly. Milk, dairy products. Whole , condensed milk , cream, fresh non-sour cream, fresh low-fat cottage cheese. Snacks Uncooked cheese. Beverages. Tea is weak with milk. Fruit and berry juices (from sweet varieties of fruits and berries), diluted with water, weak. Fats. Unsalted butter, olive, sunflower, well refined. A sample menu is given in table. The technique of dietary therapy. In addition to the quantitative composition of the diet, it is important to follow a diet. Food should be not only frequent, but also fractional, regular. Eating small amounts of food improves digestion and absorption. Patients with functional disorders of the stomach, as a rule, are treated on an outpatient basis. Follow a diet and diet should be a long time and only 2-3 months after the disappearance of all functional disorders of the stomach, you can gradually switch to diet No. 15. At first, the patient refuses mashed food, receives boiled meat with a piece, cereal is friable, vegetables are not mashed . Then 1 time per week include a weak meat or fish broth on the menu. Diet should be observed all life. Achilia functional is caused not by organic damage to the parietal cells producing hydrochloric acid, but by their deep inhibition, which is often based on nervous disorders. Among the causes of the development of functional achilia, there may be eating disorders, mainly unbalanced nutrition, for example, when consuming excess amounts of carbohydrates or fats and insufficient protein content; in case of non-compliance with the diet, violation of its rhythm, overeating, frequent use of alcoholic beverages. Dietary treatment for functional achilia is aimed at activating the secretory function of the stomach. Prescribe mechanical sparing diets containing stronger secretion pathogens. The diet is physiologically complete, with the exception of spicy dishes, smoked meats, fat mutton, pork, duck, goose, marinade, pastry, canned snacks, raw vegetables and fruits, legumes, brown bread, carbonated drinks, milk in kind when intolerant.

Violation of the motor function of the stomach. Functional hypotension of the stomach is one of the options for impaired motor function of the stomach. A typical symptom of decreased stomach tone is a constant splashing in the epigastric region during palpation. Before eating, patients feel good, after eating, they feel pressure, bursting and heaviness in the epigastric region and fast satiety. Diet therapy provides a high-calorie, nutritious, high-protein, vitamin-rich diet. Food should not contain large amounts of slag and water. It is recommended to eat food in small portions, immediately eat no more than two dishes and do not take solid and liquid foods at the same time.

General characteristics of the diet 15

A physiologically complete diet, with a high protein content and slightly higher than the physiological norm of fats and carbohydrates.
The chemical composition and calorie content. Protein 100 g (including animals 70 g), fat 100 (including vegetable 1/3), carbohydrates 500 g. Caloric value 3300 kcal. Salt -15 g. Culinary processing – the usual rational about the preservation of vitamins. Fractional diet (5-6 times a day). The temperature of a beggar is ordinary. A list of recommended foods and dishes. Bread and bakery products. White and rye bread , nechee , biscuit. Soups Different. Meat and fish dishes. Different in any cooking. Fatty varieties of pork, lamb, beef, geese, ducks are excluded. Dishes and side dishes from vegetables and mushrooms. Varied. Dishes from eggs. In any culinary processing. Fruits, berries, sweet foods and sweets. Various. Milk, dairy products and dishes from them. All kinds of. Spices. Pepper, mustard are allowed in moderation. Snacks Varied. Snack canned foods – in moderation. Beverages. Tea, coffee, cocoa, fruit and berry juices. Fats. Butter, ghee, olive, sunflower. A sample menu is given in table. Food is recommended to be taken in small portions, 5-6 times a day. Of great importance is the normalization of working conditions, adequate rest during the day, and sleep for at least 8 hours a day. Hydro-procedures (showers, rubbing with water at room temperature) have a tonic effect . Treatment at balneological resorts is contraindicated, taking a large amount of mineral water is impractical. Functional hypotension of the stomach is treated more often on an outpatient basis. Treatment should be lengthy until all clinical manifestations of the disease disappear , after 2-3 months the diet can be gradually expanded. The hypertonic state of the stomach is characterized by increased motor activity of the stomach, an increase in its tone, and convulsive contraction. Hypertension of the stomach can occur as an independent disease, often as a result of strong nervous overstrain. Secondary functional hypertension of the stomach develops in the initial stages of B1-vitamin deficiency, with some intoxications (zinc, lead), with gastritis, peptic ulcer of the stomach and duodenum, etc.

Movement of the stomach also includes spasm of the stomach, which is observed mainly in young people. The reason for almost all functional motor diseases of the stomach are stress reactions, strong nervous overstrain.
The treatment of patients with functional motor disorders is mainly dietary combined with drug therapy. The principles of constructing dietary treatment, recommended foods and dishes coincide with those for functional diseases of the secretory apparatus of the stomach. The diet is mechanically, chemically and thermally sparing prescribed until complete recovery, after 2-3 months the diet can be expanded. Dietary fractional (5-6 times a day), in small portions. Vitamin therapy is mandatory, especially B vitamins. Sometimes tranquilizers, antispasmodics, physiotherapy exercises, and hydrotherapy are prescribed .
Habitual vomiting develops as a result of a violation of the motor function of the stomach, increased peristalsis and its antiperistalsis. Not always familiar vomiting occurs due to organic lesions of the stomach. The causes of its appearance may be increased excitability of the vomiting center, mental stress, hysterical state, reflex effect on the stomach of nearby organs, etc. Vomiting may become habitual as a result of functional motor disorders of the stomach. The cause that initially caused vomiting may already work, but the established connection between eating and the act of vomiting often remains and becomes fixed. In diseases accompanied by vomiting, it begins a few hours after eating, at the height of pain; vomiting is preceded by nausea; Vomit contains a large amount of acidic liquid and food. Familiar vomiting associated with functional motor disorders of the stomach occurs immediately after or with food. Vomiting is easy. If s is the treatment, the patients lose weight, develop symptoms of vitamin deficiency, disorders of water-salt metabolism. In cases where the cause of habitual vomiting is an organic disease, treatment should begin with the underlying disease. If habitual vomiting is associated only with a violation of the motor function of the stomach, it is necessary to take into account the state of its secretory function. The principles of dietary treatment are aimed at relieving the symptoms of an “irritated stomach”. A diet is prescribed mechanically, chemically and thermally sparing, used for functional disorders of the secretory apparatus of the stomach. If habitual vomiting occurs in individuals with functional achilia, clinical nutrition should be mechanically sparing, but chemically irritating. In some cases, it is advisable to take solid and liquid foods separately. Vitamin therapy and measures aimed at normalizing water-salt metabolism are indicated. Dietary fractional (5-6 times a day), in small portions. It is recommended to expand the diet 2-3 months after clinical recovery. One of the frequent functional disorders of the stomach is aerophagia, i.e., ingestion of a large amount of air and associated belching. Aerophagy is often a symptom of organic damage to the stomach and is observed in chronic gastritis, gastric ulcer and duodenal ulcer. Dietary treatment is aimed at reducing the sensations of heaviness and raspirapiya associated with eating. Exclude nutrients that are long in the stomach (rich in connective tissue, fat), containing carbon dioxide. Clinical nutrition is similar to diet therapy prescribed for functional disorders of the secretory apparatus of the stomach. Dietary fractional (6 times a day), in small portions. In severe cases of aerophagy, a separate intake of solid and liquid food is prescribed. Vitamins are shown in large quantities, especially ascorbic acid and B vitamins. Psychotherapy is essential. Timely and adequate treatment of functional diseases of the stomach leads to a complete recovery and prevents the development of organic lesions of it.

Eosinophilic gastroenteritis – a chronic disease of the stomach, small intestine and colon, accompanied by a high eosinophilia of blood and eosinophilic infiltration of the affected tissue without the development of vasculitis . In most cases, the etiological factor of eosinophilic gastroenteritis is not known, in 20% of patients it is a food allergy. There are various options for the course of the disease: prolonged diarrhea, steatorrhea , enteropathy exudative, hypoproteinemia , iron deficiency anemia (most typical for food allergies); thickening of the muscle layer of the stomach and intestines as a result of the infiltrative process with narrowing of the intestinal lumen, the development of pyloric stenosis; mainly damage to the serous membranes, followed by ascites and eosinophilia of serous fluid. If the cause of eosinophilic gastroenteritis is food allergy, then in patients, as a rule, the level of immunoglobulin E is increased and antibodies related to immunoglobulin E are determined. The function of T lymphocytes, the content of the remaining classes of immunoglobulins, and complement of the system are without special features. Eosinophilic gastroenteritis differentiates with regional ileitis. Treatment consists in an elimination diet, desensitizing non-specific therapy, and the use of glucocorticosteroid drugs.

Benign tumors of the stomach

Benign tumors include the most diverse tumors in histogenesis (epithelial – adenomas, polyps, non – epithelial – fibromas, leiomyomas , neuromas, hemangiomas , hamartomas , etc.). Epithelial tumors, according to most researchers, are the result of regenerative processes associated with chronic gastritis. With mass preventive examinations, the detection of gastric polyps is 0.3–2.6%. Polyps occur more often with reduced secretory activity of the gastric mucosa. There are hemispherical, rounded on a wide base, rounded on the leg and stalk (finger-shaped) forms of polyps.

By pathological signs distinguish: polypous gastritis; single and multiple polyps (benign, malignant ), according to the clinical course: asymptomatic form; gastritis form; anemic form; complicated form (bleeding polyps, prolapse of the polyp in the duodenum).

Indications for removal are single and multiple polyps with a diameter of more than 0.5 cm.

Foreign bodies of the stomach are foreign bodies that invade the lumen of the stomach through the esophagus or through a wound, as well as parasites. The foreign body of the stomach may be a calculus formed in the body, phytobesoar .

Clinic of a foreign body of the stomach

A foreign body lingered in the stomach may not cause any pain for some time. A non-acute foreign body remains in the stomach for a very long time (years) and, gradually overgrowing with mucus and small food inclusions, having reached a considerable size, manifests itself as a violation of the evacuation from the stomach. Pointed foreign bodies damage the mucous membrane and underlying tissues, cause ulceration, hemorrhage, secondary infection with the development of phlegmon, perforation, peritonitis.

Diagnosis of a foreign body of the stomach

The diagnosis of a foreign body of the stomach is based on anamnesis and is confirmed radiologically and endoscopically . X -ray contrast foreign bodies (needles, nails, nuts, screws, etc.) are most easily recognized by X-ray . The question of the presence or absence of such a kind of foreign bodies in the stomach can be resolved by fluoroscopy. To clarify the position of foreign bodies, their amount, displacement , as well as to determine non-contrasting foreign bodies (various berries, phyto-, trichobesoars , roundworms, etc.), one has to resort to the study of the stomach using a contrast medium. When detecting foreign bodies of the stomach, the task of the radiologist is to track their future fate, since therapeutic tactics depend on this. If you suspect a foreign body of the stomach before radiological examination, it is strictly forbidden to take laxatives and emetics to avoid possible damage to the gastric wall by the foreign body at the time of vomiting or active peristaltic contractions. Endoscopic examination allows you to determine the localization of a foreign body, the size and its effect on the mucous membrane.

Erosive gastritis

Erosive gastritis is one of the most common causes of gastrointestinal bleeding, which is usually minor. Clinical symptoms are often absent. The disease can be combined with other forms of gastritis. At the same time, erosion may develop without previous damage to the gastric mucosa in stressful situations, when taking acetylsalicylic acid, glucocorticoids or as a result of a disturbance in the blood supply to the stomach. Erosion, as a rule, are multiple. The diagnosis is made by gastroscopy. Usually, with this disease, gastric secretion is increased, therefore, patients are prescribed antacids , and sometimes H2-histamine receptor blockers. It should be borne in mind that erosive gastritis in some cases is prone to recurrent course.