TERAPI NUTRISI PADA PASIEN STENOSIS GASTROJEJUNOSTOMI

2021 ◽  
Vol 4 (1) ◽  
pp. 24-35
Author(s):  
Amelia Jessica ◽  
Audria Graciela ◽  
Yosua Yan Kristian ◽  
Yohannessa Wulandari
Keyword(s):  
Gastric Outlet Obstruction ◽  
Outlet Obstruction

Latar belakang Stenosis merupakan komplikasi yang dapat terjadi pada pembedahan gastrojejunostomi. Stenosis dapat menyebabkan gastric outlet obstruction (GOO), yaitu terhambatnya pengosongan lambung sehingga menimbulkan keluhan mual, muntah, intoleransi terhadap makanan, penurunan selera makan, dan nyeri perut. Gastic outlet obstruction berkepanjangan berisiko menyebabkan terjadinya dehidrasi, ketidakseimbangan elektrolit, serta malnutrisi. Penurunan berat badan ditemukan pada 65% pasien dengan GOO. Laporan Kasus Tn. B, 62 tahun, dengan diagnosis tumor ganas kolon asenden, pasca laparotomi hemikolektomi dekstra, eksklusi pilorus, dan gastrojejunostomi. Sejak satu tahun sebelum masuk rumah sakit, pasien mengeluhkan mual dan muntah disertai nyeri perut hilang timbul, terutama sebelah kanan. Pada pemeriksaan didapatkan tumor pada usus besar dan dilakukan operasi hemikolektomi kanan. Saat pembedahan, terdapat perlengketan tumor pada duodenum dan saat dibebaskan terjadi cedera pada duodenum, sehingga dilakukan eksklusi pilorus serta gastrojejunostomi. Sembilan hari pasca pembedahan dilakukan relaparotomi gastrojejunostomi Roux-en-Y serta adhesiolisis akibat adanya stenosis dan adhesi. Pasien mengalami penurunan berat badan sebanyak 19 kg dalam waktu 1 tahun terakhir. Terapi nutrisi berupa diet 1420 kkal, protein 1.1g/kgBB/hari, lemak 32%, dan karbohidrat 50% dalam bentuk nutrisi parenteral. Pemberian mikronutrien enteral untuk sementara ditunda. Pemantauan dilakukan setiap hari pada pasien berupa toleransi asupan, saluran cerna, tanda vital serta keseimbangan cairan.  Kesimpulan Stenosis gastrojejunostomi merupakan komplikasi yang jarang terjadi, namun dapat mengakibatkan terjadinya GOO. Pemberian nutrisi parenteral perioperasi diberikan pada pasien yang tidak dapat mencukupi kebutuhan energi melalui oral atau enteral, serta kondisi malnutrisi berat pada pasien yang akan menjalani pembedahan. Nasogastrojejunal tube merupakan jalur pilihan pemberian nutrisi yang diutamakan pada GOO.

Temporal Trends of Peptic Ulcer Disease in Kashmir, India

JMS SKIMS ◽  
2012 ◽  
Vol 15 (2) ◽  
pp. 136-140
Author(s):  
G M Gulzar ◽  
Showkat A Zargar ◽  
Muzaffar Nazir ◽  
Gul Javid ◽  
Bashir A Khan ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Gastric Outlet Obstruction ◽  
Temporal Trends ◽  
Outlet Obstruction ◽  
Life Time ◽  
Point Prevalence ◽  
Asymptomatic Group ◽  
Ulcer Disease ◽  
Ulcer Perforation

BACKGROUND: Since late 1960s, the prevalence of peptic ulcer disease and its complications has been steadily decreasing. OBJECTIVE: To ascertain the changing trends in the prevalence and complications of peptic ulcer in Kashmir. METHODS: A cohort of 10474 people aged 15-60 years in district Baramulla of Kashmir was interviewed about symptoms, complications, and surgery related to peptic ulcer. People were enquired about smoking, use of NSAIDs, H2 Receptor antagonists, proton pump inhibitors and endoscopies. All symptomatic and randomly selected group of asymptomatic people underwent esophago-gastro-cluodenoscopy. RESULTS: In symptomatic group, 286 (41.45%) people hod peptic ulcer and in asymptomatic group 24 (5.35%) had peptic ulcer. There were 71 already diagnosed cases of peptic ulcer; totaling 381. Thirty three people had surgery for peptic ulcer. The point prevalence of peptic ulcer was 3.54% and lifetime prevalence 8.96%. The highest prevalence was in 4th decade. Bleeding was seen in 23.63%, gastric outlet obstruction 4.20%, ulcer perforation 0.52%. 9.39% of peptic ulcer patients had undergone surgery. When compared to previous study in 1985 in Kashmir, there was decrease in point prevalence of 25%, in life-time prevalence of 20.14%, Gastric outlet obstruction by 51.7%, ulcer perforation by 87%, surgery rate by 60% and bleeding by a marginal 2%. CONCLUSION: Prevalence of peptic ulcerand its complications (except bleeding) are showing downward trend in Kashmir over the last 20 years. JMS 2012;15(2):136-40

Gastrojejunostomy Versus Duodenal Stent Placement for the Palliation of Malignant Gastric Outlet Obstruction: Multicenter Randomized Trial

2009 ◽  
Vol 69 (5) ◽  
pp. AB187 ◽  
Author(s):  
Suzanne Jeurnink ◽  
Ewout W. Steyerberg ◽  
Jeanin E. Van Hooft ◽  
Casper H. Van Eijck ◽  
Matthijs P. Schwartz ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Gastric Outlet Obstruction ◽  
Stent Placement ◽  
Outlet Obstruction ◽  
Malignant Gastric Outlet Obstruction ◽  
Multicenter Randomized Trial ◽  
Duodenal Stent

scholarly journals Unusual Tissue – Unusual Issue: Pancreatic Heterotopia Presenting as Gastric Outlet Obstruction

2021 ◽  
pp. 338-343
Author(s):  
Thu L. Nguyen ◽  
Shivani Kapur ◽  
Stephen C. Schlack-Haerer ◽  
Grzegorz T. Gurda ◽  
Milan E. Folkers
Keyword(s):  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Needle Aspiration ◽  
Pancreatic Tissue ◽  
Cystic Mass ◽  
Pancreatic Heterotopia ◽  
History Of

Pancreatic heterotopia (PH) is a common, but typically small (<1 cm), incidental and asymptomatic finding; however, PH should be considered even for large and symptomatic upper gastrointestinal masses. A 27-year-old white woman presented with a 3-week history of burning epigastric pain, nausea, early satiety, and constipation. Physical examination revealed epigastric and right upper quadrant tenderness with normal laboratory workup, but imaging revealed a 5-cm, partly cystic mass arising from the gastric antrum with resulting pyloric stenosis and partial gastric outlet obstruction. Endoscopic ultrasound-guided fine needle aspiration revealed PH – an anomalous pancreatic tissue lying in a nonphysiological site. The patient ultimately underwent a resection and recovered uneventfully, with a complete pathologic examination revealing normal exocrine pancreatic tissue (PH type 2) without malignant transformation. We report a case of heterotopic pancreas manifesting as severe gastric outlet obstruction, in addition to a thorough diagnostic workup and surgical follow-up, in a young adult. Differential diagnoses and features that speak to benignity of a large, symptomatic mass lesion (PH in particular) are discussed.

Modified endoscopic ultrasound-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS): a pilot study

Endoscopy ◽  
2021 ◽  
Author(s):  
Amanda Marino ◽  
Ali Bessissow ◽  
Corey Miller ◽  
David Valenti ◽  
Louis Boucher ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Stent Migration ◽  
Stent Insertion ◽  
Ultrasound Guided ◽  
Double Balloon ◽  
Low Residue Diet ◽  
The Mean

Abstract Introduction We recently developed a double-balloon device, using widely available existing technology, to facilitate endoscopic ultrasound-guided gastroenterostomy (EUS-GE). Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS). Methods This was a single-center retrospective study of consecutive patients undergoing M-EPASS from January 2019 to August 2020. The double-balloon device consists of two vascular balloons that optimize the distension of a targeted small-bowel segment for EUS-guided stent insertion. The primary end point was the rate of technical success. Results 11 patients (45 % women; mean [standard deviation (SD)] age 64.9 [8.6]) with malignant gastric outlet obstruction were included. Technical and clinical success (ability to tolerate an oral diet) were achieved in 91 % (10/11) and 80 % (8/10) of patients, respectively. There was one adverse event (9 %) due to stent migration. Two patients (18 %) required re-intervention for stent obstruction secondary to food impaction. The mean (SD) time to a low residue diet was 3.5 (2.4) days. Conclusion M-EPASS appears to facilitate the technique of EUS-GE, potentially enhancing its safety and clinical adoption. Larger studies are needed to validate this innovative approach to gastric outlet obstruction.

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