Patients after gastrectomy and resection of the stomach
The operation of gastrectomy - complete removal of the stomach with both glands, regional lymph nodes, ending the direct connection of the esophagus with jejunum. The patient loses body of mechanical and chemical processing of food and internal secretion and stimulates blood-forming organs (the factor of Castle.) Frequent complication of this operation is a syndrome of reflux oesophagitis - throw the contents of the jejunum to the esophagus, irritation of the latter (before the formation of ulcers), pancreatic juice and bile. The syndrome occurs more often reflux after ingestion of fatty foods, milk, fruits, and expressed a feeling of acute pain and a burning sensation behind the breastbone and in the epigastric region. Acceptance of hydrochloric acid neutralizes the alkaline pancreatic juice and soothes the pain. If reflux symptoms lasts a long time, depletes the patient, it is recommended radiographic or endoscopic examination to exclude possible recurrence of the disease. Significantly more likely than after resection, gastrectomy dumping syndrome is complicated (see below).
Anemic syndrome after gastrectomy is reflected in the growing anemizatsii (anemia) associated with diarrheal illness. It is a consequence of the absence of factors Castle, produced by the gastric mucosa.
After total gastrectomy disorders and found a general nature: malaise, fatigue, progressive weight loss.
Preventing these complications is possible. It is strict adherence to the prescribed patient diets and diet. Undergoing total gastrectomy (in 1.5-3 months after surgery): sodium hypo physiologically complete a diet high in protein, reduced fat and complex carbohydrates to the lower limit of normal and severely restricting carbohydrates, with moderate limitation of mechanical and chemical stimuli, mucosal membrane receptor system and gastrointestinal tract. Eliminate stimulants secretion and pancreatic secretion. All dishes are boiled or steamed, not grated. Eating 5-6 times a day in small portions, chewing food thoroughly, taken together with weak solutions of hydrochloric acid or citric acid. Systematic monitoring of nutrition on growth of the patient-weighted index - (weight in kg * 100 / height in cm). The value of this index in the range of numbers 33-38 indicates a satisfactory nature of the food below 33 - the decreased above 38 - about good nutrition patient. Energy - 2500 - 2900 kcal / day.
Full physiological rehabilitation of patients occurs at a later date - the end of the first year after surgery. Psychosocial rehabilitation in some patients interferes with hypochondria. Before surgery, they are worried about the question of how much cut out? After the operation - how to live without a stomach? As a result, suspiciousness they unduly restrict the power. Lack of protein and vegetable food leads to malnutrition, vitamin deficiency.
Some patients, by contrast, can not withstand prolonged adherence to food, break it, go for 3 or 4 meals a day, are not systematically take the gastric juice or hydrochloric acid solution. As a result of disturbed bowel function, manifested anemization (anemia).
Surrounding loved ones to help a patient prevent these complications. Stricter diet, as well as ignore it, it should not. Method of action - friendly conversation with the patient about the need for accurate implementation of the recommendations a doctor.
In case of difficulties need to refer to oncologists, which will complement the discussion of examples of similar patients comply with the prescribed diet, diet for a total of schedule, resulting in restoration of the normal process occurred nutrition and digestion, the patients returned to their previous work and the old household food conditions. Registered in cancer settings is a lot of patients who underwent radical surgery for gastric cancer. Of these, more than a third live after the surgery over 5 years can serve as an example the possibility of restoring a normal diet and health after such an operation, as gastrectomy. Convincing examples of these can be removed heightened mistrust, fear of complications and the need to convince the regime to perform all the appointed time.
When resection of the stomach along with the tumor is removed not the whole, and a large part of the stomach (3 / 4 or 4 / 5) with the two glands and regional lymph nodes. Stump the stomach is usually connected with the jejunum. The operation resulted in the body is deprived of the main areas of motor and secretory functions of the stomach and the output of its governing supply of food from the stomach into the intestine as its treatment. Creation of new anatomical and physiological conditions for the digestion, leading to a number of pathological conditions associated with surgical intervention, and are its consequence.
Morbid symptoms appear, called the dumping syndrome (a syndrome of relief). Insufficiently processed food from the stomach goes directly into the jejunum in large chunks. This irritates the entry of the jejunum. Immediately after eating or while it is having hot flashes, heart attack, sweating, dizziness, fainting, severe weakness. These phenomena soon (15-20 min) after the horizontal position gradually disappear. In other cases, nausea, vomiting and pain, spastic nature occur in 10-30 minutes after eating and lasts until 2:00. They - the result of rapid progress of food through the loop of the jejunum and shutdown of the digestive system of the duodenum. Immediate danger to life dumping syndrome is not, but it frightens patients and darkens their existence, without taking the necessary preventive measures. The diet should contain less carbohydrates (potatoes, sweet) and more protein and fat products. Sometimes prescribed for 10-15 minutes before eating 1-2 tablespoons of 2% solution of novocaine.
Lack of gastric motor function can make a thorough chewing of food, slow food, gastric secretory function can be resolved during the meal intake of gastric juices or solutions of hydrochloric and citric acids. In the absence of the stomach to assign split meals with meals 5-6 times a day.
The patient and family at hospital discharge receive detailed instructions on diet and nutrition. They should not be forgotten. It is recommended sodium hypo (restriction of salt), a physiologically complete diet with high protein content, normal content of the complex and rapid carbohydrate restriction, a normal-fat diet. It should be limited to the content of mechanical and chemical irritants of the mucous membrane and gastrointestinal receptor system (meats, pickles, smoked, canned food, hot, cold and carbonated drinks, alcohol, chocolate, spices, etc.) to minimize the content of nitrogenous extractives (especially purine), refractory fats, aldehydes, acrolein. Exclude strong stimulant secretion and pancreatic secretion, as well as products and foods that can cause dumping syndrome (sweet liquid infant cereal, sweet milk, sweet tea, hot soup and fat, etc.). All dishes are boiled or steamed, mashed. Energy - 2800 - 3000 kcal / day. Particular attention should be paid the value of the patient slowly eating it with careful chewing, systematic and compulsory admission hydrochloric acid solutions. To protect the enamel from the destructive action of hydrochloric acid on her usually recommend that patients prepare themselves for weak solutions of fruit juice or fruit drinks. To 1 liter of fruit fruit drink - 1 tablespoon of 3% solution of hydrochloric (HCl) acid. This acidified juice to take sips during the meal. It is harmless to teeth and pleasant. Subject to the diet, diet, regular reception of hydrochloric acid solution with full rehabilitation of the patient's rehabilitation begins in the next 4-6 months.
If symptoms of gastric disease occurs long after the operation, we must think about the possible recurrence of cancer. Lucid interval from the time of radical surgery before the signs of cancer recurrence in the gastric stump was usually lasts 2-3; for recurrence after total gastrectomy (in the region of anastomosis with the esophagus) - one year.
Aching pain in the epigastric region associated with the reception and the nature of foods, belching, vomiting is an indication for referral to an extraordinary examination of the oncologist, study its X-ray and endoscopy. This is a must and when lucid interval is much smaller.
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