消化内科病题案讨论.pptVIP

Case Discussion Early Gastric Cancer Early gastric cancer is defined as disease involving the mucosa or submucosa with or without lymph node metastasis. Early gastric cancer occurs predominantly in the distal stomach. SYMPTONS AND DIAGNOSIS Symptoms of early gastric cancer are vague and unspecific. They may mimic symptoms of benign gastric ulcer disease and may either be ignored by the patient or treated medically without further evaluation. Weight loss abdominal pain nausea anorexia dysphagia Early satiety 3. Gastric retention Gastric decompression 4. Gastric ischemic perforation Devascularization of the lesser curvature Requiring exploration, debridement, and closure the perforation 5. Diarrhea Watery in nature Tends to be worse immediately after the operation and improves with time Antidiarrheal preparations to lessen the symptoms Octreotide has some benifit How to deal with the patient postoperatively? Postop??????????????????? Long-term complications after gastrectomy 1.Recurrent peptic ulceration 2.dumping syndrome Cause: the rapid emptying of gastric contents is associated with the dumping syndrome. High -carbohydrate meals tend to worsen the symptoms This syndrome, appearing after meals, is characterized by tachycardia, diaphoresis/sweat, hypotension, and abdominalm pain, does not include diarrhea. Early dumping---food passes rapidly into the small bowel, the contents produce an osmotic gradient which draws a large volume of fluid into the bowel from the bloodstream----transient hypovolaemia Late dumping---a large bolus of carbohydrate-rich food into the small bowel provokes a steep rise in blood glucose concentration; this provokes an excessive insulin response, followed by rebound hypoglycaemia. Often more severe than early dumping. 3.Malabsorption Weight loss Vitamin B12 deficiency---due to loss of gastric intrinsic factor---may present as macrocytic anaemia Iron deficiency anaemia---due to reduced iron absorption Osteomalacia---due to malabsorptio