11/26/2017 0 Comments Gastroenterostomy And Weight LossNutritional Neuropathy Clinical Presentation: History, Physical, Causes. Peripheral neuropathies due to nutritional deficiencies have few individually characteristic signs but can be differentiated by observing other symptoms of the patient's underlying systemic disease. Neuropathies mostly affect the long fibers first, starting in the feet and progressing upward. Once they have progressed to the calf, symptoms may appear in the hands. Cyanocobalamin (vitamin B1. Alcohol neuropathy. This disease is characterized by paresthesias (decreased pain and temperature sensation in a stocking- glove distribution), pain, and weakness, especially in the feet but extending proximally to the arms, causing difficulty in climbing stairs and walking. Autonomic symptoms are less common than those listed above, but include GI dysmotility, urinary or fecal incontinence, and abnormal sweat patterns. The neuropathy may be seen in conjunction with Wernicke encephalopathy (ie, ophthalmoplegia, ataxia, encephalopathy) or Korsakoff syndrome (ie, amnestic dementia). Thiamine (vitamin B1) deficiency. Dry beriberi is characterized by severe burning dysesthesias (feet more than hands), weakness and wasting (distal more than proximal), trophic changes (shiny skin, hair loss), and acrodistal sensory loss in a graded fashion typical of dying- back polyneuropathies. Some patients do not become symptomatic, possibly because they are absorbing thiamine produced by bacteria in the large intestine. However, one half become symptomatic by 7 weeks; by 1. The neuropathy begins with fatigue and loss of sensation, pain, and heaviness in the legs. Then, pretibial edema develops, along with glove- and- stocking paresthesias and difficulty with tasks such as climbing stairs and standing on one leg. If the thiamine deficiency is long standing, muscles on the dorsum of the feet atrophy and paralysis can ensue. Difficulty with talking or swallowing may also be noted. Niacin (vitamin B3) deficiency. Pellagra is characterized by the 3 D s, which are (1) dermatitis, ie, hyperkeratotic skin lesions, particularly on hands, feet, face, and neck (sun- exposed regions); (2) diarrhea; and (3) dementia. In addition, patients may exhibit peripheral neuropathy and other CNS signs, such as depression, excitation, seizures, insomnia, dizziness, cog- wheeling of the extremities, tremor, loss of hearing, tingling fingers, muscle tenderness, and bilateral symmetric glove- and- stocking numbness. Polyneuropathy is not always associated with pellagra and may be related to accompanying thiamine or pyridoxine deficiency. Therefore, it should be considered an accompanying rather than guiding symptom. It is characterized by acrodistal sensory excitation, the itching and burning in the hands, feet, and trunk, and it sometimes manifests as hydromania, or the compulsion to immerse oneself in cold water. Malabsorption is suspected in a patient with chronic diarrhea, weight loss, and anemia. The etiology is sometimes obvious. For example, patients with malabsorption. Congratulations - you have completed Medical-Surgical Nursing Exam 15 (PM). You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%. SURGICAL OPERATIONS: surgery is the branch of medicine that treats diseases, injuries, and deformities by manual or operative methods (click here for main in. Gastric bypass surgery refers to a surgical procedure in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the. Gastrectomy Definition Gastrectomy is the surgical removal of all or part of the stomach. Purpose Gastrectomy is performed for several reasons, most commonly to. Cholecystectomy: As a high incidence of gallbladder disease (28 %) has been documented after surgery for morbid obesity, Aetna considers routine cholecystectomy. Tufts Health Plan covers weight loss surgery. This article looks at the requirements to qualify for coverage for gastric bypass, lap band, and gastric sleeve. The dysesthesias progress proximally to the knees, thighs, and hips, after which weakness in the legs becomes manifest. Paresis is rare, but bulbopontine symptoms can ensue, with abnormalities of the cranial nerves, especially the vestibular, acoustic, and ocular nerves (where symptoms manifest as optic atrophy or amblyopia), as well as seizures. Eventually, the initial peripheral excitation, erythema, and GI distress progress to cerebral and spinal defects. Finally, marasmus, cachexia, macrocytic anemia, and coma develop. Pyridoxine (vitamin B 6) deficiency or excess. This deficiency must be suspected any time a sensory polyneuropathy occurs after hyperesthesia- causalgia syndrome. First, bilateral numbness and tingling begin in the distal feet. This proceeds proximally up the feet and legs, occasionally appearing in the fingers and hands. Then pain becomes prevalent in these areas, and symptoms can include a burning sensation in the feet. In rare cases, patients experience loss of power in the legs, in which sensory loss is greater than motor loss; the etiology is axonal loss. One week after the removal of vitamin B6 from the diet, levels of xanthurenic acid increase and levels of pyridoxine decrease in the urine. At 3 weeks, EEG abnormalities manifest, and tonic- clonic seizures refractory to anticonvulsants may follow. The 4 main symptoms and signs are as follows: Cutaneous mucosal symptoms - Glossitis, conjunctivitis, cheilosis. CNS symptoms - Lethargy, decreased level of consciousness, anorexia, vomiting, seizures. Ascending sensory polyneuropathy. Anemia - Lymphopenia with eosinophilia. Neuropathy due to toxicity occurs 1 month to 3 years after the individual starts excessive consumption. Cyanocobalamin (vitamin B1. About 8. 0% of all cases are due to pernicious anemia, and another 1. Exposure to nitrous oxide can suddenly precipitate the deficiency, which should be considered in any patient who develops postoperative paresthesias. The disease predominantly affects the spinal cord; therefore, separating the painful sensory and sensorimotor paresthesias of the peripheral neuropathy from the symptoms of spinal cord involvement is difficult. Presentations vary greatly among patients. The symmetric glove- and- stocking paresthesias, or tingling in the distal aspect of the toes, numbness, coldness, a pins- and- needles feeling, and occasional feelings of swelling or constriction, are slowly progressive and insidious. Symptoms progress up the legs, occasionally affect the fingers, and culminate in weakness and spasticity. In late stages, manifestations include moderate muscular wasting, optic atrophy, sphincter dysfunction, and mental disturbances. Examples of these disturbances are mild dementia (which is often the first symptom and clinically indistinguishable from other dementias), disorientation, depression, psychosis, and persecutory delusions. The hematologic manifestation of anemia, if present, can cause weakness, light- headedness, vertigo, tinnitus, palpitations, angina, heart failure, cardiomegaly, pallor, tachycardia, and hepatosplenomegaly. GI symptoms include a sore, beefy red tongue and anorexia. If left untreated, the gait becomes ataxic, followed by paraplegia with spasticity and contractures. The subacute combined degeneration that develops results in a severe myelopathy, involving posterior columns and lateral corticospinal tracts, with other manifestations including optic (retrobulbar) neuropathy . Symptoms include hyporeflexia progressing to areflexia, decreased proprioception and vibration sense with preserved pain and temperature senses, distal muscular weakness progressing to ataxia, dysphagia, and cardiac problems, and nyctalopia (night blindness). Nystagmus, ophthalmoplegia, and blindness, and dementia follow. Symptoms vary with etiology. Patients with isolated vitamin E deficiency syndrome tend to present without the hyporeflexia, and deficiency from abetalipoproteinemia manifests as increased eye problems, in contrast with deficiency from cholestatic disease, which tends to spare the eye but causes increased psychiatric and behavioral problems. Folate deficiency. The symptoms of folate deficiency are indistinguishable from those of cobalamin (vitamin B1. Hypophosphatemia. Invariably found in patients on total parenteral nutrition, this deficiency causes tingling paresthesias in the tongue, fingers, and toes but can progress to severe weakness and areflexia, sensory loss, and cranial neuropathies. It can resemble Guillain- Barr. Other features can include peripheral neuropathy, myeloneuropathy, optic neuropathy . Clinically and radiologically it can appear similar to B1. Three distinctive patterns are most common: sensory polyneuropathy, mononeuropathies, and radiculoplexopathy. Sensory neuropathies tend to present with symmetrical numbness, burning, sharp pain, and tingling. Some also have distal motor weakness, commonly foot drop. Cramping, autonomic and bulbar symptoms, and involvement of trunk nerves may also occur. Mononeuropathies are usually asymmetric and have been described in the radial, sensory radial, ulnar, greater occipital, and fibular nerves, as well as carpal tunnel syndrome, and meralgia paresthetica. The last 2 are the most common, and the carpal tunnel syndrome is usually symmetrical. Radiculoplexopathies affect the cervical and lumbosacral regions, and are usually unilateral, causing pain and numbness followed by limb weakness but usually no autonomic or bulbar symptoms. Multifactorial disease. This paresthesia- causalgia syndrome (ie, acrodynia or burning- foot syndrome) escalates from a mild paresthesia to painful burning and freezing sensations in the feet, prominent at night, relieved with exercise. This disease may mask sensory deficits, especially those on the soles of the feet. Tobacco- alcohol amblyopia is a slowly progressive symmetrical visual field loss often described as a central haze or cloud. There is no pain, photopsia, or other positive symptoms, but loss of color vision (especially red) is more profound than the loss of visual acuity. It presents clinically as a characteristic retrobulbar optic neuropathy with slow evolution and a classical cecocentral scotoma with an appearance of . Read medical definition of Colectomy. Colectomy: An operation to remove all or part of the colon (large intestine). Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the. Professor Basil Ammori is a Consultant Bariatric Surgeon at Salford Royal Hospital (NHS), Consultant Hepatobiliary Surgeon at North Manchester General Hospital (NHS.
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