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Re: [MGB-TRUTH] HERE'S YET ANOTHER COMPLICATION OF THE BILLROTH II

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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

> ===============================================

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> ===============================================

> UNSUBSCRIBE by sending an email to

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> ===============================================

--

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

----------------------------------------------

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