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Alcohol and Sedatives
Published in Frank Lynn Iber, Alcohol and Drug Abuse as Encountered in Office Practice, 2020
Alcohol is absorbed slowly from the stomach, but extremely rapidly from the small intestine. Ingestion with food, particularly fatty or hypertonic foods, retards gastric emptying and slows absorption. After gastric surgery with gastroenterostomy, absorption is fast, comparable to direct duodenal instillation. Some 50% of a dose of intraduodenally administered alcohol is absorbed in 3 min. In contrast, 50% of an oral dose taken with a meal requires 30 to 60 min for absorption. There is a large first-pass effect of alcohol that is approximately 25% of the initial drink, but less as the liver enzymes become saturated. Alcohol is rapidly distributed in the total body water and also dissolves in bilipid membranes such that its volume of distribution is slightly greater than the body water content. Absorption is always complete.
The Twentieth Century
Published in Arturo Castiglioni, A History of Medicine, 2019
The concept of peptic ulcer has undergone considerable modification as to incidence, pathogenesis, and therapy. The present century is marked by the recognition of the greater frequency of duodenal ulcer, as popularized by the surgeon Berkeley, Lord moynihan (1910), far outranking gastric ulcer in numerical importance. The psychological concepts of Sir Arthur Frederick hurst (1879–1944) contributed much to the understanding of the course and nature of peptic ulcer. B. W. sippy’s treatment of ulcer (1915) has become widely established; Einar meulengracht, of Copenhagen, introduced the clinical concept of liberal feeding of bleeding ulcers. The surgical treatment of peptic ulcer has also made noteworthy advances. Gastroenterostomy as a curative operation is discredited; subtotal gastrectomy, devised by H. von haberer (b. 1875) and popularized by H. finsterer (b. 1877) and Jeno polya (b. 1876), and in America by A. A. berg (b. 1872), marks a new era in the surgery of peptic ulcer. The relative merit of medical and surgical treatment is no longer a controversial subject, though many other aspects of the problem of peptic ulcer are still unsolved.
Weight Loss by Surgical Intervention
Published in Nathalie Bergeron, Patty W. Siri-Tarino, George A. Bray, Ronald M. Krauss, Nutrition and Cardiometabolic Health, 2017
Karim Kheniser, Sangeeta Kashyap, Nathalie Bergeron, Patty W. Siri-Tarino, George A. Bray, Ronald M. Krauss
In the early postoperative period, patients with biliopancreatic diversion achieve weight loss through early satiety and the corresponding attenuation in food intake, which are induced by rapid gastric emptying through the expanded gastroenterostomy and distention of the post-anastomosis bowel by undigested chime (Koopmans et al. 1982; Koopmans and Sclafani 1981). About 4–6 months thereafter, weight loss is mediated by malabsorption even when eating behavior is retained (food consumption can mimic or exceed presurgery), due to the presence of a limited intestinal absorptive capacity for fat and total energy (Marceau et al. 1998; Scopinaro et al. 1998, 2000). Specifically, fat and total energy absorption decrease as total consumption increases (negative correlation) (Scopinaro et al. 2000). However, this may be modulated by increasing alimentary and common limb lengths, which purportedly increases protein and decreases fat malabsorption, respectively (Hess and Hess 1998; Scopinaro 1997). Furthermore, a positive correlation exists, with respect to protein and calcium intake and the absolute quantity that is absorbed (Scopinaro et al. 2000). Therefore, calcium and protein deficiencies may be amenable to increased caloric consumption of foods enriched in these nutrients.
Combined endovascular and surgical treatment of a giant celiac artery aneurysm with consequent gastric outlet obstruction: a case report and literature review
Published in Acta Chirurgica Belgica, 2023
Nick Smet, Thijs Buimer, Tim Van Meel
After the patient’s intake returned to normal, the feeding tube was removed. Regression of biochemical cholestasis was seen. The patient made an uneventful recovery and was discharged after one week. After three months, he returned to the outpatient clinic with recurrent gastric outlet obstruction, and blood test showed no cholestasis. Control CT demonstrated no regression of the aneurysm and compression of the duodenum. It was decided to perform a gastroenterostomy in order to deviate the compressed duodenum. Due to persistent gastroparesis and thus ineffectiveness of the gastroenterostomy alone, a complemental Roux-en-Y anastomosis was made. The further postoperative course was uneventful. The last visit in the outpatient clinic was in October 2021, the patient had no residual digestive complaints and has gained weight. A CT abdomen was conducted which showed decrease of the aneurysm from 14 to 6 cm.
Retrieval anchor-assisted endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction
Published in Scandinavian Journal of Gastroenterology, 2020
Jinlong Hu, Guoxin Wang, Kai Zhang, Nan Ge, Sheng Wang, Jintao Guo, Xiang Liu, Siyu Sun
Endoscopic gastroenterostomy is an emerging approach in the management of GOO, including NOTES gastroenterostomy and EUS-GE. Compared with laparoscopic gastroenterostomy and endoscopic stent, endoscopic gastroenterostomy is a minimally invasive method associated with high rates of long-term effectiveness. EUS-GE might be the most optimal method, as it involves fewer changes of endoscopic instruments while helping achieve the desired anastomotic distance [18]. However, EUS-GE remains technically challenging, as the small intestine has a narrow lumen and is not dilated under normal conditions [19]. There are several key aspects to performing this procedure. The present study incorporated some of the recently proposed improvements to the procedure associated with increases success rate of EUS-GE.
Marginal ulcers and associated risk factors after Roux-en-Y gastric bypass
Published in Baylor University Medical Center Proceedings, 2023
Matthew Wynn, Kristen M. Tecson, David Provost
Of the 43 patients, 24 (56%) presented on an elective basis, all of whom were treated with resection of the gastroenterostomy and reanastomosis (Table 1). These patients underwent this surgery a median of 90 [33, 136] days following initial consultation for the ulcer. The remaining 19 patients (44%) presented with perforation in an urgent setting, all of whom were treated with omental patch repair of the perforated ulcer. Only 2 (11%) of these 19 patients subsequently underwent elective resection of the gastroenterostomy and reanastomosis. Forty (93%) of the 43 patients were managed laparoscopically. An open approach was used for the other 3 (7%) patients, all of whom presented with perforation. The location of the ulcers varied among patients. A total of 24 (56%) were located at the gastrojejunal anastomosis, 14 (33%) were on the jejunal side, and only 1 (2%) on the gastric side. There were 12 (28%) located anteriorly, and only 1 (2%) posteriorly. Additionally, there was 1 (2%) duodenal ulcer and 1 (2%) pyloric ulcer on the gastric remnant. In the other 2 patients, the location of the ulcer was not reported. Other intraoperative findings included stricture (14, 33%), gastrogastric fistula (7, 16%), and bleeding (8, 19%). The median time to ulcer was 6 [2, 10] years, with 15 (35%) patients requiring surgery within 5 years of their index procedure. Table 2 lists findings related to the clinical course. The median length of stay for all patients was 3 [2, 5] days. Postoperatively, 7 patients (16%) required admission to the ICU. There were no deaths within 30 days of surgery; however, one patient expired at a skilled nursing facility after discharge more than 30 days from surgery, and one patient expired over a year later due to complications from alcoholic cirrhosis.