Traumatic rupture of the oesophagus and stomach.
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Analgesics↗
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Results for “STOMACH DILATATION”
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Giant hypertrophic gastritis of Basenji dogs.
Giant hypertrophic gastritis is a newly recognized disease of adult Baseji dogs similar to Menetrier's disease of man. It is characterized by weight loss, diarrhea, dry coat, pale membranes, anorexia, raised convoluted rugae in the body of the stomach, palpable fluid- and gas-filled intestines, colonic inflammation, and radiographically demonstrable dilated intestinal loops. Laboratory findings include leukocytosis, neutrophilia, low hemoglobin, hypoalbuminemia, hypobetaglobulinemia, hypergammaglobulinemia, decreased serum fatty acids, hypocholesterolemia, indicanuria, low fecal pH, and increased fecal fat and nitrogen. Four dogs studied had gastritis with hypertrophy and diffuse lymphocytosis and plasmacytosis of the small intestine.
Animals↗
Conditions of the stomach and small intestine: differential diagnosis and surgical management.
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Animals↗
Intraoperative monitoring of regional wall motion abnormalities for detecting myocardial ischemia by transesophageal echocardiography.
Transesophageal two-dimensional echocardiography has been used for intraoperative monitoring of regional wall motion of the left ventricle. Regional wall motion abnormality is a sensitive indicator of myocardial ischemia and the use of two-dimensional transesophageal echocardiography may have a substantial advantage for early detection of myocardial infarction and thus for initiating timely and appropriate therapy in preventing postoperative myocardial ischemia. With an expected increase in the use of intraoperative transesophageal echocardiography for monitoring regional wall motion, we described the practical aspects of transesophageal echocardiography: (1) insertion technique of transesophageal echocardiographic probe; (2) the technique for obtaining an optimal short-axis view of the left ventricle; and (3) the method for evaluating regional wall-motion abnormality and myocardial ischemia. Regional wall motion abnormality is best monitored at the mid-papillary muscle level where all three coronary arteries meet. In obtaining this view, the transesophageal echocardiographic probe was found to be predominantly located in the stomach. Failure in obtaining short-axis view of the left ventricle at this level occurred in patients with left ventricular dilatation or obesity. Because of the anatomical reason, the echocardiographic transducer cannot reach a proper plane. In anesthetized patients, air can be pushed into the stomach during induction and may disturb the visualization. The pitfalls in examining regional wall motion abnormalities include: (1) shifting of the center of left ventricular contraction; (2) inadequate direction of the scanning plane; and (3) paradoxical septal movement. Three cases are presented to demonstrate the usefulness of transesophageal echocardiography in managing coronary artery surgical patients.
Aged↗
[Acute gastric dilatation in Duchenne's muscular dystrophy].
A 15 year old boy with Duchenne muscular dystrophy had severe pain in the lower abdomen and complained of nausea and bilious vomiting. A physical examination and an abdominal X-ray indicated an acute gastric dilation. With a treatment policy of administering nothing orally, a downward-hanging stomach tube and the intravenous administration of fluid the symptoms subsided. In Duchenne muscular dystrophy there may also be atrophy of the smooth muscle layers, in addition to the known progressive atrophy of striated skeletal and cardiac muscle. This may cause clinical dysfunctioning of the gastro-intestinal tract in the second decade of life.
Abdominal Pain↗
Prader-Willi syndrome: causes of death in an international series of 27 cases.
Prader-Willi syndrome (PWS) is a complex condition with many medical and psychological features. In individuals with this syndrome, causes of death were studied. Data of 27 case reports were collected. Ages at death ranged from neonatal to 68 years. None of the individuals were treated with growth hormone (GH). Most cases were not completely documented and autopsy was performed in a minority of cases only. In five cases, death was considered not to be causally related to PWS. Hypotonia with hypoventilation was noted in the babies, and acute respiratory illness with unexpected sudden death was experienced in young children with PWS. Two young children died after a short period of fever and gastroenteritis. Obesity and its complications leading to death were pronounced in the adult group. One (possibly two) adult(s) died from gastric dilatation and shock. Based on these data, some cautious conclusions can be drawn. In babies with PWS hypoventilation is a risk factor; upper airway infection may be more serious than anticipated and any other clinical features pointing to an infection should be taken very seriously. Therefore, young infants with PWS hospitalized with an upper airway infection and/or hypoventilation or gastroenteritis symptoms, should be closely monitored. Early diagnosis and prevention of overweight is a major factor in preventing early causes of death in individuals with PWS. In the adult group, weight reduction is important but difficult to manage. Sleep apnea should be recognized and treated. Pain in the upper stomach and/or vomiting should be taken as a possible sign of acute intestinal dilatation; intravenous support may be life saving.
Adolescent↗
Endoscopic mucosal resection for esophageal and gastric mucosal cancers.
Accumulated data from surgically resected specimens reveal that mucosal cancers of the esophagus and stomach pose low risk of lymph node metastasis. The author used endoscopic mucosal resection (EMR) as curative treatment in 142 cases of esophageal cancer and 102 cases of stomach cancer. In absolutely indicated cases there has been no local or distant metastasis during the longest period of follow-up (nine years). One perforation and one post-treatment severe stenosis, which was resistant to dilation therapy in the esophagus, were encountered. Deeper layer resection (including partial proper muscle) occurred in the stomach in three cases where the lesions were positioned to the lesser curvature of the upper part of the stomach. Two cases of gastric mucosal resection leaving residual cancer were successfully treated by laser ablation. No case has required further surgery. Resected specimens were contributed to histological evaluation in all cases. In conclusion, EMR can be considered as the first-line treatment for selected cases of early stage esophageal and stomach cancer.
Carcinoma, Squamous Cell↗
Endoscopic balloon dilation of the pylorus after esophagogastrostomy without a drainage procedure.
The necessity to perform a drainage procedure after esophagectomy using the stomach for substitution remains controversial. Transection of the pyloric sphincter may cause severe and debilitating gastroesophagitis because of increased duodenogastric reflux. Omitting the drainage procedure may lead to gastric stasis. In the patient group we studied (n = 50), 42 had partial esophagogastrectomy and intrathoracic esophagogastrostomy, 12 with and 30 without a drainage procedure. Eight had total thoracic esophagectomy and cervical esophagastrostomy using the entire stomach without a drainage procedure. Gastric stasis was not observed in the 12 patients with a drainage procedure, but in six, duodenal reflux gastroesophagitis caused considerable morbidity. This complication was seen only once in the group (n = 38) who did not have a drainage procedure. Four of the 38 patients with an intact pylorus (one patient after partial esophagogastrectomy and three patients after total thoracic esophagectomy) showed persistent pyloric closure. However, this complication was successfully managed by endoscopic balloon dilation under fluoroscopic survey. The results suggest that, after esophagectomy, the integrity of the pyloric sphincter should be preserved, since the complication arising from this policy can be simply managed by endoscopic balloon dilation.
Anastomosis, Roux-en-Y↗
Cholecystokinin and stomach distension combine to reduce food intake in humans.
The aim of this study was to test the hypothesis that gastric distension can enhance the effect of cholecystokinin (CCK) on reduction of food intake in men and women. Eight normal-weight subjects of each gender were tested four times each with either CCK or saline infusion crossed with gastric distension or no distension. Intravenous infusion of a low dose of CCK octapeptide (CCK-8; 112 ng/min for 23 min) combined with a subthreshold gastric distension induced by a water-filled balloon (300 ml) resulted in a significant (means +/- SED: 191 +/- 61 g in men, 209 +/- 61 g in women, and 200 +/- 43 g combined) reduction in intake of a liquid meal compared with saline infusion and unfilled gastric balloon. This combined effect was the result of a large and significant CCK effect when the stomach was distended (CCK vs. saline with distension: 169 +/- 43 g) and a small and insignificant distension effect (distension vs. no distension without CCK: 31 +/- 43 g). The CCK effect alone on intake (CCK vs. saline) without distension was not significant in men (72 +/- 61 g) but was significant in women (121 +/- 61 g). These results are consistent with the hypothesis that CCK's suppression of food intake is enhanced when the stomach is distended.
Adult↗
[Surgery in bleeding stenosing pyloroduodenal ulcer].
The results of surgical treatment of 147 patients with a bleeding stenosing pyloroduodenal ulcer are presented. The operation of choice in this pathology is a selective proximal vagotomy in combination with the original methods of ulcer excision and drainage operations, and as well a selective proximal vagotomy with antrectomy. Gastric resection is indicated in patients with decompensated stenosis of gastric outlet and pronounced disorders in motor-evacuatory function of the stomach. In patients with a severe, or extremely severe state, the ulcer excision in combination with pyloroduodenoplasty dilating the lumen is expedient.
Adolescent↗
Management of gastro-oesophageal reflux.
Parental reassurance and thickened feeds are the only requirements in the management of infants with reflux when this is the sole detectable gastro-oesophageal abnormality. In view of the strong propensity for spontaneous clinical resolution and the excellent results achieved by conservative management, infants with reflux due to a partial thoracic stomach (hiatal hernia) uncomplicated by a stricture should be treated in the first instance by postural therapy, with or without thickened feeds and supplements of antacids, domperidone, and cimetidine. Those showing no response after an adequate period of conservative treatment should have an antireflux operation. The Belsey MK IV type of fundoplication is preferred. Only an exceptional patient will require to be treated surgically before 12 months of age. The same surgical antireflux procedure, combined with oesophageal dilatations as necessary, is the treatment of choice for patients with a partial thoracic stomach complicated by a reflux oesophageal stricture. A similar treatment regimen should be followed for patients with reflux after repair of an oesophageal atresia. Surgical correction is mandatory for all infants with reflux due to a large combined hiatal hernia.
Antacids↗
Role of L-arginine-derived nitric oxide in cholinergic dilation of gastric arterioles.
The role of L-arginine-derived nitric oxide (NO) in cholinergic vasodilation of resistance vessels was studied in the intact stomach of the rat, utilizing an in vivo microscopy technique. Two L-arginine analogues, NG-monomethyl-L-arginine (L-NMMA) and nitro-L-arginine methyl ester (L-NAME), were used to block NO synthesis. Cholinergic dilation of gastric submucosal arterioles was induced by topical application of various concentrations of acetylcholine (ACh) (10(-7)-10(-4) M). Intravenous but not topical administration of L-NMMA and L-NAME caused an increase in arterial pressure. Intravenous or topical L-NAME reduces resting arteriolar diameter. These findings support the contention that NO formation modulates basal vascular tone and suggest that NO release may play a significant role in the regulation of the gastric circulation. L-Arginine analogues attenuated the arteriolar dilating effect of ACh but not adenosine or nitroglycerin. Substantial arteriolar responses to ACh remained after systemic or topical treatment with either L-NMMA or L-NAME. These results indicate that the L-arginine-NO pathway accounts only in part for ACh-induced vasodilation in gastric resistance vessels in vivo.
Acetylcholine↗
Effect of 16,16-dimethylPGE2 on gastric emptying and intestinal transit of a barium-food test meal in man.
The effect of 140 mug of 16,16-dimethyl PGE2 on gastric emptying and intestinal transit of a barium-food mixture has been studied in 8 healthy male volunteers. The propagation of the test meal was followed from the stomach to the colon by fluoroscopy wit repeated photograph ic recording. It was found that this analog significantly enhanced the rate of gastric emptying in most subjects, and the food-contrast medium also appeared sooner in the colon following the prostaglandin analog. In addition, the duodenum and the first part of the jejunum had a flaccid and dilated appearance on several occasions after administration of prostaglandin. The more rapid emptying of the stomach after administration of the prostaglandin analog is probably explained by a decreased duodenal resistance towards the gastric outflow; the earlier appearance of contrast in the colon could partly be due to the more rapid gastric emptying following administration of the prostaglandin analog.
Adult↗
Motility characteristics of innervated and denervated antral pouches in dogs. Response to antral distention and pentragastrin administration.
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Animals↗
Endoscopic dilation of late stomal stenosis. Its use following gastric surgery for morbid obesity.
We have observed 16 cases of stomal stenosis occurring late after gastric surgery for morbid obesity. In one patient no stoma was apparent in the pouch on radiographic or endoscopic examination and reoperation was required for complete obstruction. We dilated stenoses in the remaining 15 patients. Stenosis in the three earliest patients in our series were dilated with Eder-Puestow dilators. All subsequent patients have received endoscopic dilation with pneumatic balloon catheters. Ten patients remain asymptomatic following dilation. Two patients have occasional vomiting, which is ameliorated by metoclopramide hydrochloride, despite a sufficiently patent stoma. Two patients with a torsion of the stoma received no benefit from dilation, and one patient with a sufficiently patent stoma has experienced frequent vomiting. Surgery has been repeated in the latter three patients. The technique of endoscopic pneumatic balloon catheter dilation is a safe and effective means of dilating stomal stenoses occurring late after gastric surgery for morbid obesity.
Catheterization↗
The superior mesenteric artery syndrome and acute gastric dilatation in eating disorders: a report of two cases and a review of the literature.
OBJECTIVE: The pathophysiology and symptomatology of the superior mesenteric artery syndrome (SMA syndrome) is discussed. METHOD: A review of much of the available literature concerning the SMA syndrome and the associated condition acute gastric dilatation is offered. RESULTS: Two new cases of acute gastric dilatation in patients with eating disorders, one of whom was diagnosed with SMA syndrome, are presented, along with a discussion of these conditions in reference to the eating disorders. CONCLUSION: The SMA syndrome and gastric dilatation are rare but potentially a very serious complication of eating disorders, and clinicians who work with these patients should be aware of such problems.
Adult↗
Gastric necrosis in a patient with bulimia.
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Adult↗
Prenatal diagnosis of gastrointestinal obstruction: a correlation between prenatal ultrasonic findings and postnatal operative findings.
The impact of prenatal sonographic diagnosis of oesophageal and gastrointestinal obstructions has been analysed over a 10-year period. Three groups of patients were evaluated. The first group consisted of 46 newborns with abnormal prenatal sonograms, 41 of which were confirmed to have intestinal obstruction postnatally. The second group consisted of 17 neonates with normal prenatal sonograms who had intestinal obstruction postnatally. The third group included 56 newborns who did not undergo a prenatal sonogram but who had intestinal obstruction confirmed at surgery. Polyhydramnios without the appearance of a stomach on ultrasound was diagnostic of pure oesophageal atresia. Polyhydramnios with intestinal dilation was diagnostic of intestinal obstruction. Although surgery was performed earlier in the infants diagnosed prenatally with ultrasound, mortality was no less than in the group that did not undergo a prenatal sonogram, probably because of the high incidence of associated anomalies.
Esophageal Diseases↗