Gastric Suction Research Articles

Metabolic Alkalosis After Massive Blood Transfusion

METABOLIC alkalosis is commonly observed after major surgery. It is usually due to loss of acid by gastric suction and increased bicarbonate regeneration by the kidneys. 1 We report a case in which the administration of large amounts of blood provided an exogenous load of bicarbonate precursors that worsened a preexisting alkalosis. The latter was promptly corrected by hemodialysis. Report of a Case A 48-year-old man maintained on hemodialysis since 1969 was admitted to the hospital on June 12, 1975, with the acute onset of bleeding in the upper portion of the gastrointestinal tract that was shown, on endoscopic examination, to originate from a duodenal ulcer. He received antacids and 9 units of leukocyte-poor packed red blood cells (RBCs) during the following week because of intermittent bleeding. On the 12th day, he underwent vagotomy, pyloroplasty and oversewing of a bleeding duodenal ulcer. One week later, a gastrostomy was done after

Hepatic rupture from anticoagulant therapy.

Serious complications can occur with long-term warfarin therapy even though prothrombin times are kept within the accepted therapeutic range, as illustrated by the following case. REPORT OF A CASE A 69-year-old woman was admitted to the North Carolina Baptist Hospital with a three-day history of acute, right-sided, colicky, epigastric pain that radiated into the right shoulder. She had been taking warfarin sodium for six years, and was being treated for angina pectoris with erythrityl tetranitrate and nitroglycerin. She had no history of abdominal trauma. On admission, her prothrombin time was 21.5 seconds with a control of 12.0 seconds. Roentgenograms showed no signs of intestinal obstruction. She was given narcotics, vitamin K, and transfusions of whole blood. After she vomited coffee-ground-like material, gastric suction was started through a nasogastric tube. Her hematocrit reading and blood pressure level fell slowly and her severe pain persisted. Eighteen hours after admission, an exploratory celiotomy

Renal reabsorption of bicarbonate in puppies: effect of extracellular volume contraction on the renal threshold for bicarbonate.

Extract: It has been recognized for many years that infants have lower concentrations of bicarbonate in plasma than older children and adults, due neither to a limited renal capacity to excrete hydrogen ion nor to a reduced capacity for reabsorption of bicarbonate, but to a low renal threshold for bicarbonate. The purpose of the present investigation was to determine whether the neonate and young of another species also could be shown to have a “physiologic acidosis” and, if so, to use this model for exploration of factors that might influence the threshold for bicarbonate. Mean pH of blood and concentration of bicarbonate in plasma in 11 young suckling puppies were 7.24 ± 0.018 and 18.2 ± 0.55 mmoles/liter, respectively, levels considerably lower than those found in adult dogs. In all but one animal pH of urine was below 6.0. Inasmuch as puppies thus appear to be in a state of “physiologic acidosis” and to have no limitation in acidification of the urine, we feel that this animal provides a suitable model for further examination of the characteristics of renal reabsorption and excretion of bicarbonate during immaturity. Titrations of bicarbonate performed in the usual manner demonstrated a threshold of 17–20 mmoles/liter, with a mean of 18.3. In the absence of significant volume expansion, maximal rates of reabsorption of bicarbonate were not observed despite filtered loads that were double those at threshold. Fractional excretion of sodium during control periods in animals which were not dehydrated averaged 2.9 ± 1.8% compared with 0.16 ± 0.08% in animals which were slightly dehydrated by their previous treatment with ammonium chloride. In this group, by replacement of gastric fluid (primarily sodium and potassium chloride) with a solution of sodium and potassium bicarbonate, renal handling of bicarbonate at varying filtered loads could be studied in the absence of volume expansion and with the continued stimulus for reabsorption of sodium. Under these circumstances, the renal threshold for bicarbonate was found to be markedly increased (25.2 ± 1.12). Saline was administered to two animals after the threshold had been passed. At any given level of filtered load the rate of excretion of bicarbonate in urine after administration of saline greatly exceeded the rate of excretion during gastric suction. The data in the present study thus indicate that the decreased threshold for bicarbonate in the young animal is not due to a limitation in intrinsic capacity for reabsorption of bicarbonate, inasmuch as capacity could be increased markedly under the stimulus

Enzyme cytochemistry of the abraded gastric surface epithelium. An aid in the diagnosis of early atrophic gastritis and focal intestinal metaplasia.

Enzyme cytochemistry of the abraded gastric mucosa was here developed as a new procedure and applied to the study of atrophic gastritis. This new technic consists of determining 5 enzymes in the superficial epithelium of the gastric mucosa, abraded by conventional cytologic brush technic—namely, alkaline phosphatase, acid phosphatase, leucine amino peptidase, lactic acid dehydrogenase and diphosphopyridine nucleotide diaphorase. Enzyme cytochemistry of the abraded surface epithelial cells was correlated, in 49 individuals, with the histology and cytology of the gastric mucosa, as obtained by gastric suction biopsy and conventional cytologic technic. In addition, in 31 of these patients, enzyme histochemistry of the gastric surface epithelium, obtained by gastric suction biopsy, was studied and correlated with enzyme cytochemistry of the smears of the abraded surface epithelium of the stomach. The results obtained indicate similar yields of cytochemical and histochemical methods in individuals with normal gastric mucosa and chronic superficial gastritis. However, enzyme cytochemical study of the abraded mucosa appears to be superior to histologic and enzyme histochemical examination of the gastric suction biopsy specimens in recognizing the early atrophic lesions of the gastric mucous membrane. These manifest themselves by positive reactions of the abraded surface epithelium for acid phosphatase, lactic acid dehydrogenase and diphosphopyridine nucleotide diaphorase. Enzyme cytochemistry is especially important in diagnosing the focally distributed intestinal metaplasia, which is often missed in gastric suction biopsy. This can be easily recognized by strongly positive reactions of the abraded surface epithelium for alkaline phosphatase and leucine amino polypeptidase. In view of the relation existing between the foci of intestinal metaplasia and development of gastric cancer in this area such a recognition may be significant in the followup of patients presenting this type of lesion.

Spontaneous submucosal haematoma of the oesophagus: "oesophageal apoplexy".

The cases are reported of two patients who developed severe persistent retrosternal pain and dysphagia whilst eating, one of whom also vomited small amounts of bright blood. Both were found to suffer from an intramural hæmatoma of the lower œsophagus associated with fever and pleural reaction, suggesting at least temporary mediastinitis in one case. Both patients were managed successfully by means of conservative treatment including gastrostomy, gastric suction and pyloroplasty in order to avoid reflux, and the avoidance of oral feeding. Whilst this report was being prepared a very similar case was reported by Marks and Keet (1968). This brings the number of cases reported to four: one, reported by Thompson et alii (1967), in which the patient was managed surgically but did not survive, the one reported by Marks and Keets (1968), and the two reported here, in which the patients were managed conservatively and recovered.

Low anterior resection in the community hospital.

Summary The bowel must be well prepared. The anastomosis should not be jeopardized by use of too many sutures. The perineal floor is not closed; the anastomosis is left intraperitoneally where it can be protected by omentum or small bowel in the event of a separation. A tube cecostomy is a valuable adjunct in a difficult resection. Oral feedings should be allowed only after satisfactory restoration of bowel function. Bandages are removed permanently on the first postoperative day, and showers and baths are allowed as soon as the patient is sufficiently ambulatory. Colon surgery can be done effectively without the use of drains, prophylactic postoperative antibiotics, or prophylactic postoperative gastric suction.

Gastric mucosal diaphragm.

AGASTRIC mucosal diaphragm is a thin membranous septum which partially occludes the outlet of the stomach and usually causes some degree of gastric obstruction. Since this unusual anomaly is surgically correctable, its preoperative recognition is important. Four cases are presented to emphasize its clinical, pathologic, and roentgen features. CASE I: This 78-year-old Negro gave a history of three years of intermittent epigastric pain and fullness aggravated by eating and relieved by vomiting, which occurred a half hour or more after meals. The vomitus consisted of undigested food. The symptoms gradually worsened, and he lost about 5 pounds. Three weeks before admission to Cincinnati General Hospital, he went on a liquid diet, which relieved the vomiting. Physical examination revealed a thin, edentulous man, normal except for mild cardiomegaly and hyperactive bowel sounds. Routine laboratory studies were normal. An upper gastrointestinal series showed considerable gastric retention, and prolonged gastric suction was required to permit a satisfactory roentgen study. A persistent band-like constriction was seen about 2 ern proximal to the pylorus (Fig. 1). Although barium flowed freely through the area, the stomach was dilated. Films from a study three years earlier showed similar findings. At operation, the distal antrum was partially obstructed by a soft, pliable mucosal diaphragm with a central opening 3 to 4 rnrn in diameter. The diaphragm was incised but not removed, and a Mikulicz pyloroplasty was performed. Roentgen study a year later was normal. CASE II: For two years this 74-year-old Caucasion male complained of nausea and vomiting of undigested food three to four hours after meals. Six months before admission to Cincinnati General Hospital, the symptoms worsened and he lost his appetite, with a consequent weight loss of 30 pounds. Physical examination disclosed a thin, dehydrated, elderly man with epigastric fullness. A stool specimen showed a 4+ guaiac reaction. Routine laboratory studies were normal. Upper gastrointestinal examination showed a persistent, smooth, linear, transverse, prepyloric defect partially obstructing the gastric outlet (Fig. 2). At times, the defect appeared to prolapse into the bulb. At laparotomy, the stomach looked normal except for the thickening of its walls and some scarring over its external surface secondary to a prior cholecystectomy. Upon opening of the stomach, a mucosal diaphragm located 1 to 1.5 cm proximal to the pyloric ring was found (Fig. 3). It showed a central aperture approximately 3mm in diameter. The diaphragm was excised and pyloroplasty performed. The excised tissue revealed a layer of normal submucosa and hypertrophied muscularis mucosae sandwiched between two layers of gastric mucosa. There was moderate nonspecific inflammation but no fibrosis. The patient became asymptomatic postoperatively.

Gastric Suction in X-Ray Diagnosis: A New Method

In roentgen examination of the upper gastrointestinal tract the gastric secretion dilutes the barium, making the study more or less futile. Because of poor suction or incorrect position of the tube tip, aspiration with the usual stomach pump is often unsuccessful. The secretion may be removed completely, however, by continuous suction and a tube fitted with a steel ball (Figs.1 and 2). The vacuum is regulated by finger-tip control.

Gastric suction in infants—Problems of fluid replacement therapy : T. Bardini, U. Bosio and D. Pavesio. Minerva Pediat. 17:1427, 1965

Gastric suction in infants—Problems of fluid replacement therapy : T. Bardini, U. Bosio and D. Pavesio. Minerva Pediat. 17:1427, 1965

Abdominal surgery without gastrointestinal suction.

THE ROUTINE use of gastric decompression by means of nasogastric suction-drainage has been practiced by most surgeons since its introduction by Ward 1 and Wangensteen 2 in 1925. Due to the frequency of complications 3,4 with nasogastric suction, Gilchrist 5 and Farris and Smith 6 suggested, as a substitute, temporary gastrostomy as a means of gastric decompression. However, complications have also been reported with gastrostomy. 7,8 The elimination of nasogastric suction and gastrostomy has been discussed in several recent reports. Gerber reported, in 1958, 9 the successful treatment of 1,000 patients with paralytic ileus without nasogastric suction. In this series, 300 consecutive cases of paralytic ileus in which suction drainage of the stomach was used were compared with another 300 cases in which suction was not used. Patients without suction had less morbidity and mortality. Patients in whom gastric suction was used had a higher incidence of respiratory tract complications.

The Basic and Clinical Studies of the Gastric Suction Biopsy

The Basic and Clinical Studies of the Gastric Suction Biopsy

Protein content of gastric juice.

EDITORIALSYNOPSISInitially itisdemonstrated thatthebiuret methodisan accurate methodof determining protein concentration whentheprotein hasbeensubjected tovarying degrees ofacid hydrolysis andpeptic digestion. Using continuous gastric suction, andthebiuret methodofmeasuringprotein concentration, theprotein content ofgastric juice ina series ofconditions was determined. Gastric cancerpatients have ahigher basal protein concentration thancontrol subjects and duodenal ulcer patients andgastric ulcer patients have ahigher protein concentration thanduodenal ulcer patients. Instimulated gastric juice, duodenal ulcer patients have alower protein concentration thangastric ulcer andgastric carcinoma patients andcontrol subjects. Thebasal protein outputs were similar inthefour groupsstudied. There was no correlation between theprotein andD.N.A.content ofgastric juice. Theprotein lost into thestomach may varybetween 1 and16g.perday.

SUPPRESSION OF SECRETION AND CONTROL OF PAIN IN PANCREATITIS.

We have no ideal treatment for the suppression of hormonal secretory mechanisms and neural secretory mechanisms, or for the control of pain. These must await a better understanding of the exact mechanisms leading to the production of pancreatitis. Suppression of secretion is probably best maintained by gastric suction in severe cases, accompanied by parenteral anticholinergic drugs. The usual pain with pancreatitis is best controlled by Demerol, and more severe pain by repeated use of epidural local anesthetic block. Steroids are not commonly used because their danger is greater than their helpfulness. Diamox and other less commonly used drugs, though theoretically helpful, have not been tried frequently enough in patients with pancreatitis to assay their real value in this disease.

AN APPARATUS FOR CONTINUOUS GASTRIC SUCTION.

Medical Journal of AustraliaVolume 2, Issue 8 p. 306-307 New Appliances AN APPARATUS FOR CONTINUOUS GASTRIC SUCTION First published: 01 August 1964 https://doi.org/10.5694/j.1326-5377.1964.tb115767.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue8August 1964Pages 306-307 RelatedInformation

Gastric-cell maturation disorders in atrophic gastritis, pernicious anemia, and carcinoma. Histologic site of origin and diagnostic significance of abnormal cells.

Cytologic specimens were obtained with an all-nylon gastric brush and histologic specimens with a gastric suction biopsy instrument from 50 individuals, including patients with atrophic lesions of the gastric mucosa and carcinoma.

Observations on postoperative vomiting

We have selected 123 patients who vomited twice following complete recovery from anaesthesia; these were then treated with anti-emetic drugs. Children and patients with gastric suction were excluded. The incidence of this degree of vomiting was 3.6 per cent. Most of our patients were females. There was a higher incidence of vomiting than expected following caesarian section, ophthalmic surgery, and gynaecological operation but not after abdominal operations. The duration of the operation, the type of anaesthesia, the position oi the patient, and the preoperative medication did not appear to have a significant influence. About 50 per cent of the patients did not vomit after receiving treatment. Of the two main drugs used, prochlorperazine proved to be more effective than trimethobenzamide. In patients where an initial injection of anti-emetic had not abolished vomiting, subsequent treatment with the same drug or with another anti-emetic was less effective. Since vomiting may develop into a major postoperative complication in patients of this last group special attention should be directed to their management and these patients should be taken into consideration when the therapeutic value of an anti-emetic drug is investigated.

Postoperative decompression by temporary gastrotomy or nasogastric tube. An objective comparison.

Since the report of Farris and Smith 3 in 1956, temporary tube gastrostomy has been more frequently used to replace the nasogastric tube when prolonged postoperative gastric suction is anticipated. The complications and discomfort caused by the nasogastric tube are well known. 2-4 The benefits and complications of the gastrostomy have been adequately reviewed. 8-11 As yet, however, there has been no report in which the postoperative morbidity and mortality accompanying each of these 2 methods of decompression has been compared. Such a study should provide objective evidence to support practical indications and contraindications for a temporary tube gastrostomy. In this study the postoperative complication and mortality rates have been compared in 2 groups of patients. In one group, gastrostomy was used, and in the other, nasogastric suction. Both groups of patients were operated upon during the same 5 year period, 1956 to 1961. The decision for or against a

Studies on the Relationship Between the Reduction of TTC and the Concentration of Oxygen in the Substrate Solution

1. The gastric suction biopsy was performed on the patients (about 150 cases) who had suffered from the stomach trouble, and the histochemical findings of the human gastric mucsa and the gastric acidity were investigated.2. Histamine or atropine administration was induced in rats, and the histochemical findings of the stomach at the various stages of the administration were successively investigated.3. The alkaline and acid phosphatase, adenosinetriphosphatase, succinic dehydrogenase, diphosphopyridinenucleotide diaphorase and leucine aminopeptidase activities were investigated.4. The enzymatic activities of the gastric mucosa were shown in Table 1.5. Succinic dehydrogenase, diphosphopyridinenucleotide diaphorase and acid phosphatase activities were in parallel with the gastric acidity comparatively.6. Nothing dehydrogenase was investigated in the present study.

Acute gastric dilatation

A series of seventeen fatal cases of acute gastric dilatation were briefly reviewed as a background to a general discussion of the clinical aspects of this problem as well as the causative factors. It is apparent that no one cause is responsible for gastric dilatation, but a combination of respiratory difficulty associated with conditions predisposing to paralytic ileus is the most usual situation. Occasionally, a localizing factor may be present which can produce a chronic dilatation of the stomach with an acute exacerbation. A series of experiments was performed to investigate the defects of gastric dilatation on a normal animal and appeared to show that severe mechanical respiratory and hemodynamic changes are induced which lead to profound biochemical and physiologic changes. The best treatment is a general awareness of the problem so that early diagnosis can be made at a time when simple gastric suction will alleviate the problem. The longer it persists, the more resuscitation will be necessary in the form of fluid and blood. If allowed to remain unchecked, the changes may be irreversible.

Practical Clinical Management of Electrolyte Disorders

The author feels that this subject is generally considered complex, unpredictable, and bewildering. Most texts are physiologically and chemically oriented. This monograph approaches the problem of describing the clinical syndromes. The author is an internist, but his first chapter, on alkalosis, is devoted to five cases seen in consultation on the surgical service. These must have been seen some time ago, since four of them had infusions of sodium lactate in conjunction with sulfadiazine therapy. Gastric suction also contributed to the alkalosis. In the author's opinion intravenous ammonium chloride is always necessary in the treatment of alkalosis. The reviewer has always found saline satisfactory since it has a 50 mEq/L excess of chloride. We both agree that potassium chloride must often be added. The second chapter presents and discusses a patient with congestive failure and stresses the renal and hormonal basis for fluid retention. Production of a hyperchloremic acidosis and