Editing Gastrectomy (section)

=== '''Metabolic     disturbances''' ===

** Iron deficiency anaemia (30%      of patient)
*** Combination of decreased       iron intake, impaired iron absorption, and chronic blood loss
*** Generally corrected with       oral supplements
** B12 deficiency anaemia
*** Risk is dependent on the       amount of stomach removed
*** Occurs secondary to lack of       intrinsic factor meaning no B12 absorption
*** Subtotal gastrectomy       patients should have lifelong B12 supplementation
** Osteoporosis/osteomalacia
*** Appears to be caused by       deficiencies in calcium
*** Risk increases with the       extent of gastric resection, and is usually associated with a Billroth       II
*** Typically develops 4-5       years post-op
*** Give calcium and vitamin D       supplements
*** Patients with Billroth II       that bypasses the duodenum should also have vitamin ADEK supplements