Pathophysiologic findings of bile reflux gastritis. How is it managed? Bile reflux gastritis occurs when ablation or dysfunction of the pylorus results in stasis of bile in the stomach. The diagnosis is made with the following triad of findings: A. Postprandial epigastric pain accompanied by nausea and bilious emesis B. Evidence of bile reflux into the stomach …
management of duodenal stump disruption (blow-out) after truncal vagotomy, antrectomy, and Billroth II reconstruction. Patients presenting with postoperative localized right upper quadrant tenderness are managed by aggressive percutaneous drainage of the abscess under radiologic guidance. An acute abdomen with free perforation and leakage of duodenal contents into the peritoneal cavity may require surgical management. This includes reclosure …
How is postoperative gastroparesis treated? Postoperative gastroparesis typically occurs in patients who undergo surgery for GOO. Evaluation should begin with esophagogastroduodenoscopy, upper GI series with small bowel follow-through, and gastric emptying scan. Once mechanical obstruction has been ruled out, medical treatment is successful in most cases. Prokinetic agents such as erythromycin and metoclopramide may be …
What are the Visick criteria? The Visick criteria are used to grade outcome after surgery for PUD: Grade I—No symptoms Grade II—Mild symptoms that do not affect daily life Grade III—Moderate symptoms that affect daily life and require treatment but are not disabling Grade IV—Recurrent ulceration or disabling symptoms Grades I and II are considered …
What are the long-term outcomes and risks for complications after truncal vagotomy and drainage, truncal vagotomy and antrectomy, and highly selective vagotomy? Truncal vagotomy and antrectomy, although having the lowest recurrence rate, also has the highest morbidity and mortality. Highly selective vagotomy, although having the lowest morbidity and mortality, has the highest recurrence rate. The …
Comparison of Surgical Options for Peptic Ulcer Disease Read More »
Role for endoscopic and laparoscopic management of GOO secondary to PUD Patients treated with balloon dilatation, without treatment of H. pylori infection have a higher rate of failure and recurrent obstruction. Patients who are negative for H. pylori do not respond favorably to balloon dilatation and should be considered for surgical treatment early in the process. Laparoscopic truncal vagotomy …
Role for endoscopic and laparoscopic management of GOO secondary to PUD Read More »
How is GOO caused by PUD surgically managed? GOO can result from an acute exacerbation of PUD in the setting of chronic pyloric and duodenal scarring. Classically, patients with GOO present with nausea, emesis, early satiety, and weight loss. Although radiologic contrast studies are useful in evaluation, upper endoscopy is critical to rule out a …