After total gastrectomy, the small intestine is generally used to construct a circular intestinal collaterals for temporary storage of food, but since the stomach also has the functions of secreting gastric acid to sterilize and further grind food as well as secreting proteases to digest food, these functions man-made intestinal collaterals cannot reach.
1, dietary hygiene.
2, adequate chewing to reduce the burden on the intestine.
3, supplementing the diet with points between three meals;.
4, supplementation with iron and vitamin B12 to prevent anemia.
5, supplementation of calcium and vitamin D to prevent calcium deficiency
There is no special contraindication to eating fruits.
The cause of heartburn is due to alkaline intestinal fluid reflux stimulating the esophagus.
First, the amount of food should be gradually increased, not too fast.
Secondly, you should not lie down immediately after eating; you need to put your upper body up at night when resting.
The normal diet usually takes until 4 weeks later. Your attending doctor should have special instructions when you are discharged from the hospital (diet). Some greasy meat, cold, dry, hard, coarse fiber and other indigestible food should be avoided. Also, milk and sugar can cause flatulence, so don’t eat them. Egg custard can first eat a little to see your father’s gastrointestinal receptivity, the specific situation decided. You can do appropriate exercise, which will help digestion and absorption. If you continue to have adverse symptoms such as epigastric fullness and even vomiting acid, you can take morpholine and compound phenelpatine with the permission of your doctor to help relieve the symptoms. Also, pay attention to your father’s blood sugar level and adjust your diet calories accordingly according to it. I suddenly thought of a point to add to you, you can start eating a normal diet of one or a few capsules of garlic and a large red and white radish every day (can be cooked softer and drink the water in which the radish is cooked), but start with a small amount to observe the stomach’s ability to adapt, the right amount is good.
After total gastrectomy, the most powerful impact is the absorption of calcium, research found that the absorption of calcium and vitamin D in the gastric sinus and proximal duodenum. Pay attention to the above-mentioned substances after the operation. After total gastric resection, food peristalsis is accelerated, so patients need to eat small and frequent meals and not to eat cold and hard foods. Some plant foods such as yellow and red vegetables and fruits contain β-carotene, which can be converted into vitamin A in the liver. Foods with high calcium content include various soy products, dairy products and oatmeal, cabbage, cabbage, carrot, celery, pumpkin, radish, spinach, zucchini, leek, dandelion and winter squash. Certain hard fruits and seeds are also high in calcium, such as dried almonds, walnuts, hazelnuts, sunflower seeds, etc. Fruits include oranges, etc. Some vegetables such as spinach, amaranth, water spinach, etc. contain oxalic acid, which affects the absorption of calcium, so vegetables containing high oxalic acid can be blanched in boiling water first, so that some of the oxalic acid dissolves in the water first, and then stir-fried. Note that adding leavening agent to flour, corn flour and bean flour and extending the fermentation time can make phytic acid hydrolysis and free calcium increase, so that calcium can be easily absorbed. Patients after total gastrectomy should preferably take intravenous supplementation of folic acid and vitamin B12 once a year.
Suggestions: 1 Whatever the food, first of all, it should be broken up to ensure easy digestion.2 Foods to eat: mushrooms, bean sprouts, chicken, pork, millet, ginger, garlic, soy milk, asparagus, tofu, apples, pasta sheets, meat loaf, noodles, tomatoes, eggs, cucumbers, fungus, round onions, cauliflower, broccoli, eggplant, groundnuts, carrots. When cancer patients receive chemotherapy, if they can eat more carrots, it can reduce the chemotherapy reaction.
Life care: Eat less and more meals, regular diet. Pay attention to home care and health care, regular life, eat more good absorption, good digestion, fresh food, not to eat beef and mutton, dog meat, chicken, fish and shrimp, cilantro, fennel dishes and other spicy food.
Patients with total gastrectomy are prone to dumping syndrome.
Symptoms appear during or within 30 minutes after a meal and last 15-60 minutes, and can be alleviated by lying down after a meal. The early postprandial symptom group mainly includes two groups of symptoms: one group is gastrointestinal symptoms, the most common is the feeling of fullness after a short meal, followed by epigastric distension and discomfort, nausea and vomiting, vomit is alkaline containing bile, abdominal colic, increased bowel sounds, diarrhea, loose stools, etc.; the other group is neurocirculatory symptoms, palpitations, tachycardia, sweating, dizziness, pallor, fever, weakness, lower blood pressure, etc.
Disease etiology blood sugar blood volume
After gastrectomy, the patient loses the regulatory function of the pylorus, the residual gastric volume is reduced, as well as the vagus nerve is removed to affect the postprandial gastric diastole, so that a large amount of hyperosmolar chyme is dumped into the duodenum or jejunum abruptly after eating.
Pathophysiology
Regarding the mechanism of symptom generation, it is widely believed that.
1, a large amount of food directly into the small intestine makes the intestinal canal expand and dilate, and hypertonic food in the small intestine draws out a large amount of body fluid from the intestinal wall also makes the intestinal canal expand and dilate.
2, the expansion of the intestinal canal can cause an autonomic reflex response, so that the intestinal wall releases 5-hydroxytryptamine, bradykinin, substance P, other intestinal vasoactive intestinal peptides, etc., which leads to increased intestinal peristalsis and vasodilation and circulatory symptoms such as decreased blood pressure and increased heart rate caused by the latter.
3. Infiltration of extracellular fluid into the intestinal lumen can cause a decrease in effective circulating blood volume and a decrease in serum K+, which aggravates the occurrence of circulatory symptoms. Food is emptied more quickly in the standing position, and the above symptoms become more pronounced. In conclusion, the postprandial symptom cluster is a combined response to the above 3 factors.
Gastrointestinal symptoms
Often after a meal, especially 20 – 30 minutes after eating a large amount of carbohydrates, patients may feel epigastric distension, fullness and discomfort, nausea, sometimes accompanied by vomiting, belching, abdominal rumbling and flatulence, sometimes with a sense of urgency to defecate and diarrhea.
Dumping syndrome treatment of vasodilatory symptoms
Concurrent with the onset of gastrointestinal symptoms, dizziness, vertigo, occasional syncope, extreme weakness, tremors, profuse sweating, and a flushed or pale complexion, as well as tachycardia and, in severe cases, decreased blood pressure may occur.
Patients can often find for themselves that lying down for a few moments after a meal can quickly relieve symptoms or avoid an attack. In order to prevent or reduce the occurrence of symptoms, patients are often reluctant to eat more, so they can often lose weight.
Diagnostic tests
Diagnosis: The diagnosis of dumping syndrome lacks objective criteria, and its diagnosis is established based on detailed medical history. Early dumping syndrome mostly occurs 1 to 3 weeks after surgery when eating starts, and symptoms appear within 1 h after meals, while no symptoms appear in the fasted state, and fluid and sugar-rich foods are particularly difficult to tolerate, and the degree of symptoms varies, and clinical symptoms can be divided into systemic somatic symptoms and gastrointestinal symptoms. Systemic physical symptoms: dizziness, palpitations, tachycardia, extreme weakness, profuse sweating, trembling, pale or flushed face, or in severe cases, decreased blood pressure and fainting; gastrointestinal symptoms: warm feeling in the upper abdomen, fullness, nausea, vomiting, belching, intestinal tinnitus, diarrhea, and sometimes a sense of urgency to defecate. Usually lasts for about 1h and can be relieved by itself, and the attack can be avoided by lying down after meals. Severely ill patients may lose weight due to fear of eating and often show signs of malnutrition.
Treatment of dumping syndrome
Late dumping syndrome mostly develops more than six months after surgery, and hypoglycemic symptoms such as weakness, hunger, panic, sweating, dizziness, anxiety and even confusion and syncope appear 1 to 3h after meals. The majority of patients have early-onset dumping, or early-onset dumping and late-onset dumping exist at the same time. A small number of patients exhibit only late onset dumping. Some researchers have used a simple oral glucose stimulation-induced tipping syndrome test: an increase in heart rate of 10 beats/min or more for 1 h after 50 g of oral glucose is a sensitive (100%) and specific (92%) indicator for the diagnosis of early-onset tipping syndrome. The hydrogen breath test reflects rapid migration into the distal ileum or colon after oral glucose and has a sensitivity of 100% and a somewhat lower specificity.
Laboratory tests: Some studies have shown a role for the 5-hydroxytryptamine, kinin-palmitin system in dumping episodes, but the evidence is not compelling. Glucagon is significantly higher in patients with dumping after glucose administration, and similar responses are seen with vasoactive intestinal peptides, YY peptides, pancreatic polypeptides, and neurohypophyseal peptides.
Other ancillary tests: no relevant information is available.
Differential diagnosis
Because this sign has characteristic manifestations such as typical postprandial fullness, sweating, tachycardia and decreased blood pressure in patients after major gastrectomy, it is easily distinguished from other causes of hypoglycemia and hypotension.
Treatment options
Antihistamine or anti-acetylcholine agents as well as antitussive and sedative drugs are available. In recent years, anti-5-hydroxytryptamine drugs have also been tried with some success. Growth inhibitors have also been reported to be effective in the literature. In a small number of patients with significant symptoms, surgery can be considered when the above drug treatment and preventive measures are ineffective. There are many types of surgical methods used in clinical practice. In principle, there is no other method than narrowing the anastomosis, replacing the gastrojejunostomy with a gastroduodenal anastomosis, or transplanting a section of jejunum between the stomach and duodenum (jejunostomy), all of which aim to slow down the rate of food entering directly into the jejunum.
Treatment measures
Eat small and frequent meals, lie down for 15-30 minutes after meals, and make it a habit to drink water between meals or on an empty stomach. Limit sugar consumption and increase protein and fat appropriately. Take anticholinergic drugs such as prulbenecid 15-30mg half an hour before a meal to slow gastrointestinal motility. Methylsulfonylurea (D860) 0.5-1.0g or insulin 4-8u can shorten the duration of hyperglycemic symptoms. In mild to moderate cases, the symptoms can be reduced or cured within months or years with medical treatment. Severe cases can be treated surgically.
Prevention
Prevention: If you have symptoms after eating, you should lie down, try to eat solid food with high nutrition and easy to digest, eat less and more meals, and avoid too sweet, too salty, too thick diet and dairy products, drinking water and liquid food can be taken between two meals instead of at mealtime, most patients have mild symptoms in the early postoperative postprandial symptom group, after a period of gastrointestinal tract adaptation and diet regulation, the symptoms can disappear or be easily controlled.
Complication symptoms
1.Dizziness, palpitations, tachycardia, extreme weakness, profuse sweating, trembling, pale or flushed face, and in severe cases, decreased blood pressure and syncope may occur.
2.Late dumping syndrome mostly develops more than six months after surgery, and hypoglycemic symptoms such as weakness, hunger, panic, sweating, dizziness, anxiety and even confusion and syncope appear 1 to 3h after meal.