A post partial gastrectomy patient presents with neurological symptoms. Most probable diagnosis is:
Ref: Bailey unci Love's Short Practice of Surgery 25th EditionExplanation:Postoperative complications of gastrectomyLeakage of the oesophagojejunostomy.Leakage from the duodenal stumpParaduodenal collectionsBiliary peritonitisThe presence of septic collections along with a very radical vascular dissection may lead to catastropic secondary haemorrhage from the exposed or divided blood vessels.Long-term complications of surgeryReduced gastric capacityDumping and diarrhoeaNutritional deficiencies may especially vitamin B12 deficiency (Since Intrinsic factor secreted by parietal cell of stomach is necessary for vitamin B32 absorption)Symptoms of Vitamin B12 deficiencyThe main syndrome of vitamin BI2 deficiency is Biermers disease (pernicious anemia).It is characterized by a triad of symptoms:Anemia with bone marrow promegaioblastosis (Megaloblastic anemia).This is due to the inhibition of DNA synthesis (specifically purines and thymidine)Gastrointestinal symptoms.This may also be due to the autoimmune attack on the parietal cells of the stomach in pernicious anemia.Neurological symptoms:Sensory or motor deficiencies (absent reflexes, diminished vibration or soft touch sensation)Subacute combined degeneration of spinal chordDementiaPsychiatric symptoms may be present.
Folic acid deficiency
Thiame deficiency
Vitamin B12 de fid ency
Iron deficiency
Postgastrectomy Complications