Point out from among the following the most likely complication presented by a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12:
The statement has described the clinical features of this syndrome. It is usually a late complication (the patient was operated 20 years ago for a Bilroth II, remember that it is a partial gastrectomy, closure of the gastric stump and anastomosis of the first jejunal loop to the stump), it is accompanied by postprandial pain, abdominal distension. What has occurred is a stenosis of the afferent loop, so that biliary and pancreatic secretions do not mix with the bolus, they accumulate, produce pain that is relieved by vomiting, fat absorption is not possible (lack of pancreatic lipase), so there is diarrhea, and if associated with bacterial overgrowth, there is malabsorption of vitamin B12. If it were gastric adenocarcinoma, they would have spoken of constitutional syndrome, extradigestive manifestations (sister Maria Jose node, Krukenberg tumor, Virchow node). It is not dumping because it does not speak of vegetative symptoms (palpitations, facial flushing, etc...). Biliary reflux gastropathy is an endoscopic diagnosis, moreover it is not associated with diarrhea or malabsorption.
Biliary reflux gastropathy.
Gastric adenocarcinoma.
Rapid gastric emptying syndrome (dumping).
Afferent loop syndrome with bacterial overgrowth.
Biliary reflux gastropathy is an endoscopic diagnosis, moreover it is not associated with diarrhea or malabsorption.
If it were gastric adenocarcinoma, they would have spoken of constitutional syndrome, extradigestive manifestations (sister Maria Jose node, Krukenberg tumor, Virchow node).
It is not dumping because it does not speak of vegetative symptoms (palpitations, facial flushing, etc...).
What has occurred is a stenosis of the afferent loop, so that biliary and pancreatic secretions do not mix with the bolus, they accumulate, produce pain that is relieved by vomiting, fat absorption is not possible (lack of pancreatic lipase), so there is diarrhea, and if associated with bacterial overgrowth, there is malabsorption of vitamin B12.