Postoperative gastrointestinal complications

Functional disorders of the gastrointestinal tract are very a common postoperative phenomenon. They are characterized vy increased sympathetic irritation and increased levels of catecholamines in the blood. Gas arrest with transient intestinal paresis andvomiting are considered a normal reaction of the body in the first 24 hours after surgery. The basic postoperative complications include acute gastric dilatation, erosions and ulcers, ileus and parotid gland inflammation.

Acute gastric dilatation
Acute gastric dilatation – the state of obstruction of the upper digestive tract at which the dilatation and congestion of the stomach and sometimes duodenum. Leftovers, gastric juice, pancreatic juice, duodenal secretion and bile accumulate in the dysfunctional part. This content leads to dilatation of the stomach. The stomach wall can also be chemically damaged enzymatically by the stomach contents, thus allowing microbes to pass into the blood with subsequent bacteremia. The consequences of damage to the gastric mucosa also include the development of erosions and ulcers with subsequent possible bleeding. The contents of such a stomach are green-brown, hemorrhagic in case of bleeding, sour-smelling.

Gastric ectasis is manifested by abdominal pain, abdominal pressure, nausea, gas arrest, and eventually repeated vomiting of large contents. Declining diuresis, the patient is restless and suffers from tachycardia. Physical examination methods, such as tapping and palpation can demonstrate stomach enlargement.

Treatment is based on nasogastric tube removal of stomach contents. Parenteral replacement of fluids and ions is important. Saline gastric lavage is also effective and used.

Erosions and ulcers
In addition to the stomach, they laso occur in the duodenum, esophagus and small intestine. They always occur only on the mucosa. The cause of their formation is also increased acidity or a long-established probe in the digestive tract. They are dangerous mainly due to bleeding and perforation.

The treatment is aimed at eliminating the cause of the body's stress reaction, these lesions heal spontaneously very quickly after the removal of this cause. Co-administration of antacids, H2-blockers and ß-adrenolytics is suitable.

Ileus
Stopper of intestinal peristalsis leads to the accumulation of gaseous and liquid contents accompanied by many symptoms. One of them is the displacement of the diaphragm with airway oppression, respiratory disorders (superficial and accelerated breathing), or tachycardia. Correction of intestinal peristalsis under physiological conditions after surgery will come within 3 days.

There are several types of ileus: ileus neurogenic (paralytic, spastic), vascular (conditioned by mesenteric vessel occlusion - acute, chronic) and ileus mechaniccal (either simple - caused by occlusion of the intestinal lumen or ileus caused by a mechanical obstruction of the intestine, with which the mesenteric vessel is compressed) and nerves).

Paralytic ileus
Paralytic ileus belongs to the group of neurogenic ileus. It is caused by a disturbance of the balance sympathetic and parasympathetic activity. Symptoms include difficulty breathing, feeling full, vomiting, painless and enlarged abdomen without audible peristalsis. In the next stage we find dehydration, disruption of ABB, oliguria to anuria and intoxication of the organism, these symptoms are fatal without treatment. X-rays are used in diagnostics, on which hydroaeric phenomena (levels) are found, which are mainly found in the small intestine.

During treatment, it is necessary to empty the contents of the intestine using a probe (Miller-Abbot prove), which is inserted into the duodenum and replacement of lost fluids and minerals. An enema or local Priessnitz compresses are often used to support intestinal activity. If this treatment fails, and intestinal stoma is used.

Mechanical ileus
A mechanical barrier is most often caused by the fusion of the intestinal loops each other, with the omentum, peritoneum or other organ located in the abdominal cavity. The mechanical barrier can be external (tumor, abscess, adhesions), in the intestinal wall (hematoma) or in the intestinal lumen (stool, foreign bodies, parasites). Once an obstacle is located in the upper part of the intestine, we speak of a "high ileum“, if it is located in the large intestine, we speak of a "low ileum“. We speak by bowel obstruction is called an obstructive ileus, and ileus caused by adhesions without a vascular supply disorder is called adhesive ileus

This form of ileus is accompanied by severe pain in the form of convulsions, which come at intervals and are accompanied by significant peristalsis above the site of the obstacle. With this peristalsis, the organism tries to move the obstacle. As soon as the mechanical oppression of the blood vessels and nerves occur, there is intense pain with signs of shock. The most common occurence is hypovolemic shock, which arises due to the presence of the "third space", this space is formed by fluid accumulated above the obstacle. Intestinal ischemia and perforation gradually occur. ABB disorder very often occurs - at high ileumdue to vomiting, alkalosis, at low ileum from loss of Na+ to the third space, acidosis occurs.

Treatment is based on ABB (Acid-Base Balance) adjustment and surgical removal of the obstruction.

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