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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intestinal pseudo-obstruction (IP) is an uncommon disorder of gut motility which must be differentiated from mechanical intestinal obstruction. We have seen 11 such patients over the last 5 years. Characteristic symptoms, shared by mechanical obstruction, include abdominal distention and pain, nausea, and vomiting. Radiologic studies reveal dilated loops of bowel with air fluid levels. In most patients a major differentiating feature from obstruction may be the presence of diarrhea rather than obstipation. Steatorrhea is secondary to an overgrowth of anaerobic bacteria in the motionless dilated loops of bowel. IP has been associated with various disorders: in our series two patients had scleroderma, one multiple small bowel diverticula, one systemic amyloidosis, one celiac disease, and one spinal cord injury; in only two patients was the disorder considered "idiopathic." Three patients had previously undergone a jejuno--ileal bypass for morbid obesity. During the acute episode, the patients were treated symptomatically with decompression by nasogastric or rectal tube with fluid and electrolyte replacement. Malabsorption treated with broad spectrum antibiotics reversing the steatorrhea but not episodes of pseudo-obstruction. Magnesium deficiency was present in seven patients and its correction resulted in amelioration of the symptom complex. In two patients episodes of pseudo-obstruction were markedly reduced by metoclopramide which was not effective in two others.
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PMID:Chronic intestinal pseudo-obstruction. 679 59

Postoperative radiographic findings in the gastrointestinal tract were analyzed in 43 of 72 patients with gastric bypass for morbid obesity. In 15 patients studied because of early postoperative vomiting or abdominal pain, two showed leak from the proximal gastric pouch and six showed impairment of proximal pouch emptying at the anastomosis or proximal efferent loop. In four of the six, the impaired emptying was due to transient postoperative edema and improved spontaneously. Three patients had impairment of distal gastric pouch emptying due to pylorospasm. Five patients studied in the late postoperative period showed dehiscence of the gastric staple line, which can be difficult to demonstrate radiographically. Familiarity with the normal and the abnormal radiographic appearance after gastric bypass is important in elucidating the nature of the problems that can arise after this operation.
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PMID:Radiographic abnormalities after gastric bypass. 697 28

A 49-year-old woman with morbid obesity was found to have subtotal villous atrophy in an operative jejunal biopsy, taken when a jejunoileal bypass was created. After the operation, the patient developed marked weight loss, vomiting, hepatic failure, and a bizarre mental state with sudden losses of consciousness. Six months after the first operation the bypass was reversed but the patient developed hepatorenal failure and died one week after the second operation. The histological features of several biopsies of jejunum were typical of a gluten sensitive enteropathy. This, previously subclinical, small bowel disease may have contributed to her hepatic failure and death by interfering with jejunoileal adaptation. In the absence of any of the other, rarer, causes of villous atrophy, this woman appears to have had coeliac disease.
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PMID:Jejunal villous atrophy with morbid obesity: death after jejunoileal bypass. 712 9

Three hundred patients underwent gastroplasty surgery for morbid obesity. The operation consisted of formation of a 45 to 60 millilitre (ml) proximal gastric pouch with a 10 to 12 millimeter (mm) channel located on the greater curvature of the stomach. The channel was supported by a continued seromuscular inverting layer of 2-0 polypropylene and a second interrupted inverting layer of 4-0 Dacron sutures. The early postoperative complication rate was 18.7 percent, including one cardiac death, for a 0.33 percent mortality rate. Late postoperative complication rate was 27.0 percent, with vomiting heading the list. Staple-line disruption continued to be of concern with stapling in continuity. Liquid or pureed diet restriction for the first 12 postoperative weeks decreased the incidence of vomiting which contributed to early staple-line dehiscence. Two applications of the TA 90 and preservation of adequate blood supply to the pouch were important factors in the prevention of this complication. The department of clinical nutrition was directly involved in the preoperative classes in nutrition designed to assist patients in making the proper psychological adaptation to the newly imposed dietary restrictions. Over 90 percent of total weight loss occurred at 12 months. At 24 months there was a 32.5 percent decrease from preoperative weight and a 63.4 percent excess weight loss.
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PMID:Gastroplasty in intractable obesity. 730 26

Vagotomy has been shown to reduce body weight in several species of experimental animals. Due to the relative safety and simplicity of the procedure and the long-clinical evaluation of vagotomy in ulcer disease, truncal vagotomy without drainage has been performed in a series of 21 morbidly obese patients. The mean maximum body weight was 12.8 +/- 3 kg (s.e.). In the 14 patients observed for 12-40 months, the mean weight decrease is 20 +/- 4 kg (range: 0-51). Apart from lesion of the oesophagus in one patient, there have been no operative complications. In one 45-year-old patient sudden death due to myocardial fibrosis occurred three years after the operation. Four patients have had short episodes of diarrhea, and vomiting has occurred in two patients who "tested the limits'. There is no evidence of gastric dilatation or ulcers, yet gastric stasis is prevalent. Three patients are failures, two not having reduced and the third regaining 28 of her initial 31 kg weight loss postoperatively. Five patients have participated in programs for weight reduction in which they claim greater ease in complying than before operation, due to the characteristic lack of hunger sensations in all of the successful patients. The mechanisms for weight reduction after vagotomy are not known, yet seem to involve other factors than delayed gastric emptying of solids. Longer follow-up is necessary for evaluation of this procedure in the treatment of morbid obesity.
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PMID:Truncal vagotomy in morbid obesity. 730 28

Introduction of gastric bypass as treatment for morbid obesity in 1966 caused over its ulcerogenic potential as an antral exclusion procedure. However, in only 20 of our 653 patients has marginal ulceration developed. Predominant symptoms were epigastric pain, occult gastrointestinal bleeding, and vomiting. Barium contrast roentgenography was as diagnostically accurate as endoscopy in these lesions. Objective measurement ensuring creation of a gastric reservoir of 50 mL maximum size reduced the incidence of marginal ulcer from 3.8% to 0.98%. Upper pouch size determined the mode of therapy. Nonoperative therapy was successful in patients with small pouches, but did not relieve symptoms of patients with large reservoirs. Truncal vagotomy and resection of redundant upper pouch was the preferred operative approach in these patients.
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PMID:Stomal ulcers after gastric bypass. 736 64

Breastfed infants of women who have had gastric or intestinal bypass procedures may develop nutritional deficiencies. We describe a 10-month-old exclusively breastfed white male infant who presented with vomiting, failure to thrive, and megaloblastic anemia. He was found to have vitamin B12 deficiency. His mother had undergone a gastric bypass procedure for morbid obesity 2 years prior to her pregnancy with this child. She had subclinical vitamin B12 deficiency, with an abnormal Schilling test that corrected with the addition of intrinsic factor. Therefore, we believe that the mother's gastric bypass had caused a decrease in available intrinsic factor, resulting in subclinical vitamin B12 deficiency and decreased breast milk B12. Although she was asymptomatic, her breastfed infant developed symptomatic B12 deficiency. This is the first reported case of a maternal gastric bypass resulting in vitamin B12 deficiency in an infant. These mothers should receive vitamin supplements, including vitamin B12, during and after pregnancy, and may require parenterally administered vitamin B12.
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PMID:Nutritional vitamin B12 deficiency in a breastfed infant following maternal gastric bypass. 806 Aug 15

The SILASTIC ring vertical gastric bypass (SRVGBP) has evolved as the rational operation to control obesity. The operation consists of a proximal vertical gastric pouch < 30 cc in size. The pouch is banded with a 5.5-cm SILASTIC ring, and this functions as the stoma which does not stretch and is large enough to allow patients to eat all varieties of food, including vegetables and meats, with minimal incidence of postprandial emesis. The continuity of the gastrointestinal tract is formed with a Roux-en-Y gastroenterostomy with each limb about 60 cm long. The bypass of the gastroduodenal axis causes decreased digestion and thus decreased absorption of fats and carbohydrates, resulting in comparably more weight loss than seen in the standard restrictive gastroplasty. The dumping experienced in this operation, which prevents patients from becoming sweet eaters and thus provides long-term weight maintenance, is not as severe as in the regular gastric bypass with a dilatable stoma. In trained hands, the morbidity and mortality from this operation is comparable to that seen in the simple restrictive gastroplasty. The complications due to this operation include staple line breakdown, marginal ulcers, stenosis, incisional hernia, dumping, and iron, vitamins A, B12, D, and E deficiencies. These deficiencies are correctable by oral or parenteral supplements as necessary. This operation yields a 90% or higher success rate (> 40% excess weight loss) in the treatment of morbid obesity [corrected].
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PMID:SILASTIC ring vertical banded gastric bypass for the treatment of obesity: two years of follow-up in 84 patients [corrected]. 816 87

In industrialized countries, surgical gastroplasty is performed more and more frequently in patients with morbid obesity. The aims of this prospective study were to determine the incidence of upper gastrointestinal lesions in obese patients and to assess the place of digestive endoscopy in symptomatic patients after gastroplasty. A consecutive group of 159 obese patients were studied before and after vertical banded gastroplasty. In the preoperative evaluation, reflux esophagitis and gastroduodenal lesions were endoscopically observed in 31% and 37% of the patients, respectively. Interestingly, the majority of the obese patients with upper gastrointestinal lesions were asymptomatic. In the postoperative follow-up period, 55 of the 159 patients complained of upper gastrointestinal symptoms such as vomiting (72%), esophageal reflux (17%), and epigastric pain (3%). Stenosis of the outlet of the gastric pouch was described in 40 of the 55 symptomatic patients. Esophagitis was observed in 60% of these patients. Endoscopic dilation using Savary bougies or TTS balloon was successfully performed in all the patients with symptomatic stenosis of the gastric outlet. Food impaction was endoscopically removed in four patients. Thus, we recommend performing an upper gastrointestinal endoscopy in obese patients who are candidates for surgical gastroplasty because of the high incidence of upper gastrointestinal peptic lesions. Endoscopy is also helpful in patients with digestive disorders occurring after gastroplasty in order to define and to treat the lesions.
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PMID:The place of upper gastrointestinal tract endoscopy before and after vertical banded gastroplasty for morbid obesity. 939 14

Postoperative nausea and vomiting have been associated with the use of nitrous oxide. Alfentanil, when combined with nitrous oxide, also results in a high incidence of postoperative nausea and vomiting. To further define this emesis-potentiating effect of N2O, 119 patients were chosen for study and divided into two groups: group A (n = 59) was administered a mixture of alfentanil, N2O, and O2 with 0.25% isoflurane, group B (n = 60) was administered a mixture of oxygen, room air, isofluorane, and alfentanil. The incidence of postoperative nausea and vomiting was ascertained by a blinded observer in the recovery room. All 119 patients were scheduled for extra-abdominal procedures (excluding thoracotomial, intracranial, ophthalmologic, and middle ear surgery). Patients with a previous history of nausea and vomiting, hiatal hernias, reflux esophagitis, or morbid obesity were excluded. The incidence of vomiting was 5% (3/60) in group B and 15% (8/59) in group A (P = 0.067). Forty-four percent (26/59) of the patients in group A and 20% (12/59) in group B were nauseated postoperatively (P = 0.005). Our data suggest that elimination of N2O from alfentanil-based anesthetics lessens the incidence of nausea.
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PMID:Avoidance of nitrous oxide and increased isoflurane during alfentanil based anesthesia decreases the incidence of postoperative nausea. 948 78


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