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Updated: 03/11/08 12:28 PM |
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L. Case Histories
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Case I
A 35-year old woman presented with a long history of moderate, localized, upper abdominal pain which was usually relieved temporarily by eating. Antacids helped her discomfort. She smoked 10-15 cigarettes a day, but she denied using aspirin-like compounds. Four years ago an upper endoscopy at St. Elsewhere revealed a duodenal ulcer and an “inflamed stomach”. Her symptoms resolved after stopping smoking and a course of an H2 receptor antagonist. One year ago upper abdominal pain returned, and it was again relieved by an H2–blocker. After two months she stopped the medicine because she felt well. Two months ago, her discomfort recurred and she used antacids for relief. She had resumed smoking. Physical exam revealed only mild tenderness when her epigastrium was palpated.
A 56-year old housewife has long-standing arthritic pains. She is admitted to the hospital after vomiting a cup full of fresh blood and passing dark tarry stools. She has suffered from intermittent heartburn for many years which benefited from antacid preparations. On examination, she appears pale and sweaty with a radial pulse of 110 per minute. Her blood pressure is 95/60. Abdominal exam reveals moderate epigastric tenderness only. A digital rectal exam demonstrates black tarry stool which is hemoccult positive. The laboratory reports a hematocrit of 25 (normal 35).
Might a bilateral truncal vagotomy (without pyloroplasty) be useful in helping the obese lose weight? Based on your knowledge of gastric physiology, justify this proposal. |
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