Guest guest Posted September 26, 2000 Report Share Posted September 26, 2000 http://www.merck.com/pubs/mmanual/section3/chapter24/24b.htm Bezoars Tightly packed collections of partially digested or undigested material that remain in the stomach indefinitely. Partially digested agglomerations of hair or vegetable matter are called trichobezoars or phytobezoars, respectively. Food bolus (ie, a loose aggregation of pits, seeds, citrus pith, or milk coagulum [lactobezoar] in toddlers) or concretions of medication (sucralfate, aluminum hydroxide gel), shellac, or even bubble gum may mimic true bezoars and are referred to as pseudobezoars. Etiology Trichobezoars, which may weigh up to 2.7 kg (6 lb), most commonly arise in patients with neuropsychiatric disturbances. **** Phytobezoars almost always occur in patients after a Billroth I or II partial gastrectomy, ****** especially when accompanied by vagotomy. Hypochlorhydria, diminished antral motility, and incomplete mastication are the main predisposing factors. The vertical banded gastroplasty used in the treatment of morbid obesity has been associated with gastric bezoars. Diabetic gastroparesis is also a characteristic setting for bezoar formation. Finally, consumption of a unique berry, the " unpeeled " persimmon, has caused epidemics of postgastrectomy bezoars, which require surgery in > 90% of cases. ***** Symptoms and Signs Most bezoars cause no symptoms, although postprandial fullness, nausea and vomiting, peptic pain, and GI bleeding may occur. Occasionally, postgastrectomy bezoars may cause small-bowel obstruction, as the sievelike function of the pylorus is absent. Diagnosis and Treatment Usually bezoars are detected on x-ray and may be mistaken for tumors. On endoscopy, bezoars have an unmistakable irregular surface and may range in color from yellow-green to gray-black. An endoscopic biopsy that yields hair or plant material is diagnostic. Bezoars have also been demonstrated by abdominal ultrasound and CT. A food bolus requires no treatment, rocklike concretions and trichobezoars require surgery, and phytobezoars fall between these extremes. A liquid diet, gastric suction and lavage, and endoscopic fragmentation with forceps or jet spray may break up bezoars. A chemical regimen often works better: 1.2 L of dissolved cellulase (0.5 g/dL water) given orally over 24 h for 2 days. Metoclopramide 40 mg/24 h IV or 10 mg q 4 h IM for several days may increase peristalsis by accelerating gastric emptying. hsmotherof4@... wrote: > > In the interest of truth.. the following info I asked about earlier is NOT > from Dr. R's site. It is from > The Merck Manual of Diagnosis and Therapy , > Section 3.Gastrointestinal Disorders > Chapter 23. Gastritis And Peptic Ulcer Disease > <A HREF= " http://www.merck.com/pubs/mmanual/section3/chapter23/23c.htm " >http:// > www.merck.com/pubs/mmanual/section3/chapter23/23c.htm</A> > Read the complete article and see what it means to you. > > " The incidence and type of postsurgical symptoms vary with the type of > operation. Resective surgical procedures include antrectomy, hemigastrectomy, > partial gastrectomy, and subtotal gastrectomy (ie, resection of from 30 to > 90% of the distal stomach with a gastroduodenostomy-Billroth I or > gastrojejunostomy-Billroth II), with or without vagotomy. After resective > surgery, as many as 30% of patients have significant symptoms, including > weight loss, maldigestion, anemia, dumping syndrome, reactive hypoglycemia, > bilious vomiting, mechanical problems, and ulcer recurrence. " > > > =============================================== > See: http://www.fourlane.com/mgb > =============================================== > Send email to: MGB-TRUTH (AT) egroups (DOT) com > =============================================== > Read/post on the web at: > http://www.egroups.com/group/MGB-TRUTH > =============================================== > Change your settings at: > http://www.egroups.com/mygroups > =============================================== > UNSUBSCRIBE by sending an email to > MGB-TRUTH-unsubscribe (AT) egroups (DOT) com > =============================================== -- Kind regards, http://www.fourlane.com/lindat lindat @ mindspring.com (no spaces) --------------------------------------------- ROBERT R. RUTLEDGE, M.D., BUSTED! http://www.fourlane.com/mgb --------------------------------------------- Join MGB-TRUTH http://www.egroups.com/group/MGB-TRUTH ---------------------------------------------- Quote Link to comment Share on other sites More sharing options...
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