Gastric resection

Persons who have had a total gastrectomy or subtotal gastric resection (when the cells producing the intrinsic factor are totally or partially removed)... 

Anatomical defects Blind loops Strictures Fistulae Diverticula Gastric resections Ileocolonic resections... 

Risk factors for deficiency Pregnancy (neural tube defects in fetus may result) Alcoholism Severe malnutrition Risk fiictors for deficiency Pernicious anemia Gastric resection Chronic pancreatitis Severe malnutrition Vegan Infection with D. latum... 

Deficiencies of vitamin B12 can result from either low dietary levels or, more commonly, from poor absorption of the vitamin due to the failure of gastric parietal cells to produce intrinsic factor (as in pernicious anemia) or to a loss of activity of the receptor needed for intestinal uptake of the vitamin.5 Nonspecific malabsorption syndromes or gastric resection can also cause vitamin B12 deficiency. The vitamin may be administered orally (for dietary deficiencies), or intramuscularly or deep subcutaneously (for pernicious anemia). [Note Folic acid administration alone reverses the hematologic abnormality and thus masks the B12 deficiency, which can then proceed to severe neurologic dysfunction and disease. Therefore, megaloblastic anemia should not be treated with folic acid alone, but rather with a combination of folate and vitamin B12.] Therapy must be continued for the remainder of the life of a patient suffering from pernicious anemia. There are no known adverse effects of this vitamin. 

The test is valid for diagnosing severe pancreatic exocrine insufficiency but has the sensitivity limitations described above with respect to detecting mild impairment of pancreatic function. Conversely, despite the inclusion of the control test, false-positive results may occur in patients with intestinal and biliary diseases, as well as following gastric resection or Yen-Roux procedures. In the latter patients, intraluminal lack of pancreatic enzymes (despite normal secretory... 

M31. Mersheimer, W. L., Glass, G. B. J., Speer, F. D., Winfield, J. M., and Boyd, L. J., Gastric mucin—a chemical and histologic study following bilateral vagectomy, gastric resection and the combined procedure. Trans. Am. Surg. Assoc. 70, 331-342 (1952). 

Success rate The success rate for visualizing the biliary tract is 95%, whereas in patients with gastric resection (Billroth II) and Braun s anastomosis, the success rate is only 30-40%. Ultrasonography permits the differentiation between intra- and extrahepatic cholestasis in... 

D. Clinical Use and Toxicity Vitamin Bp is available as hydroxocobalamin and cyanocobalamin, which have equivalent effects. The major application is in the treatment of naturally occurring pernicious anemia and anemia caused by gastric resection. Because Bp deficiency anemia is almost always caused by inadequate absorption, therapy should be by replacement of vitamin Bp, using parenteral therapy. Neither form of vitamin Bp has significant toxicity. 

Percent Composition of Blood Serum Fatty Acids After Gastric Resection with Exocrine Pancreatic Insufficiency... 

The advent of H2RAS and PPIs has virtually abolished the need for peptic ulcer surgery except to deal with complications. For the most part, gastric resections are associated with a morbidity and are therefore avoided unless circumstances absolutely dictate surgical intervention. Gastric resections may be of some benefit in very early neoplastic disease of the stomach. 

Some examples of the numerous varieties of gastric resection devised to facilitate safety and ameliorate postoperative symptoms. 

The Billroth II anastomosis was used because it was a safer technical procedure than the Billroth I anastomosis. Although the Billroth I anastomosis often leaked, it more or less reproduced an anatomic likeness, even though the pylorus was absent. On the contrary, while the anastomosis of the jejunum to the stomach (Billroth II) rarely leaked, it produced a substantially different anatomic configuration with consequent major metabolic derangements, collectively referred to as the postgastrectomy syndrome. Unless acid-suppressive medication is unavailable, vagotomy is rarely used even if gastric resection is required. 

Only cohort studies with more than 2000 gastric resections for peptic ulcer patients with gastric and duodenal ulcer are pooled if not stated otherwise. 

Analysis of epidemiological data shows that the increased risk of gastric cancer more than 20 years after gastric resection or vagotomy and in patients with pernicious anaemia is due to chronic atrophic gastritis and is not a consequence of decreased acid secretion or hypergastrinaemia. 

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