Postoperative nausea and vomiting

Postoperative nausea and vomiting commonly occur after surgery and anaesthesia. Patients find it very distressing and this chapter sets out ways in which you can alleviate their symptoms: first by understanding the physiology and the causes of the problem and then by applying simple remedies and using well-tried and safe drugs. Mendelson’s syndrome of aspiration pneumonia is also described.

Postoperative nausea and vomiting

Postoperative nausea and vomiting commonly occur after surgery and anaesthesia. Patients find it very distressing and this chapter sets out ways in which you can alleviate their symptoms: first by understanding the physiology and the causes of the problem and then by applying simple remedies and using well-tried and safe drugs. Mendelson’s syndrome of aspiration pneumonia is also described.

Tulžies akmenų sukeltas plonosios žarnos nepraeinamumas

Algimantas Stašinskas, Juozas StanaitisVilniaus universiteto Gastroenterologijos, nefrourologijos ir chirurgijos klinika, Bendrosios chirurgijos centras, Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Tikslas Išnagrinėti retus mechaninio plonosios žarnos nepraeinamumo atvejus.Ligoniai ir metodai 1991–2009 metais buvo dešimt plonosios žarnos mechaninio nepraeinamumo atvejų, sukeltų tulžies akmenų: 9 moterims ir 1 vyrui. Išnagrinėtos ligos istorijos. Tyrimas – retrospektyvusis. Rezultatai Vidutinis ligonių amžius – 76,7 metų. Visi ligoniai buvo operuoti skubiai, esant ūminei žarnų nepraeinamumo klinikai. Dviem atvejais operacijos metu pavyko akmenis, įstrigusius klubinio aklosios žarnos vožtuvo valva ileocaecalis srityje, nustumti į storąją žarną, keturiais atvejais apsiribota enterolitotomija, vienu atveju atlikta gangrenavusios plonosios žarnos rezekcija, trimis atvejais – enterolitotomija ir panaikinta bilioenterinė fistulė (atliekant cholecistektomiją). Du ligoniai mirė. Išvada Esant mechaniniam žarnų nepraeinamumui, sukeltam tulžies akmenų, ir sunkiai ligonio būklei reikėtų apsiriboti enterolitotomija. Tais atvejais, kai operacijos rizika nedidelė, tikslinga atlikti cholecistektomiją (panaikinant bilioenterinę fistulę) ir enterolitotomiją. Reikšminiai žodžiai: nepraeinamumas, tulžies akmenys. Bowel obstruction caused by biliary stones Algimantas Stašinskas, Juozas StanaitisVilnius Universitety, Clinic of Gastroenterology, Nephrourology and Surgery, Vilniaus University Emergency Hospital,Šiltnamių str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] Objective Bowel obstruction caused by biliary stones is evaluated. Patients and methods There were 10 cases of acute bowel obstruction caused by biliary stones in 1991–2009 (9 females and 1 male). A retrospective study was performed on the basis of medical documentation. Results Only in two cases cholelithiasis was diagnosed but not referred as a cause of bowel obstruction before operation. The patients were operated on in all cases. The bigger stones (4 × 5 cm) were found in the jejunum, 2.5 × 4 cm in the ileum or the ileocecal valve. The stones were pushed forward to the cecum only in two cases. Enterotomy with stone extraction was necessary in four cases. Two patients died because of hepatorenal insuffitiency and Mendelson’s syndrome. There were cases of wound infection among the survivors. Conclusion Enterolithotomy alone should be done in cases of bowel obstruction caused by biliary stones. Key words: gallstone ileus, small bowel obstruction