■医生必须通过对胃切除术后患者的随访来警惕胰腺外分泌功能不全的诊断,不管严重程度和滞后时间。诊断时应考虑紧急白蛋白和胰酶替代。
■据记载,胃切除术后可发生胰腺外分泌功能不全(EPI)。脂肪肝,营养不良,和体重减轻是疾病的常见症状;然而,通常是轻度至中度胃切除术后。本文报道一例EPI表现为低蛋白血症导致呼吸困难和失气的病例,这不是胃切除术后EPI的典型症状。一名61岁的有胃腺癌病史的男子接受了全胃切除术和放化疗治疗,因呼吸困难和anasarca入院。尽管在另一家医院被诊断为恶性肿瘤复发,根据描述的症状,没有发现恶性肿瘤的证据.确定他的腹水和胸腔积液是由低白蛋白血症引起的。此外,他声称脂肪泻,他的粪便弹性蛋白酶低于预期。EPI是根据他的病史诊断的,临床旁测试,和考试。他在接受白蛋白和胰腺酶治疗后1年无症状。胃切除术后EPI可能严重到足以引起脂肪泻或低白蛋白血症。因此,无论演示文稿的严重程度如何,在对有胃切除术史的患者进行随访的过程中,内科医生必须对这一诊断保持警觉.诊断时应考虑紧急白蛋白和胰酶替代。
UNASSIGNED: Physicians must be alert for the exocrine pancreatic insufficiency diagnosis through the follow-up of postgastrectomy patients, regardless the severity and lag time. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed.
UNASSIGNED: It is documented that exocrine pancreatic insufficiency (EPI) can develop after gastrectomy. Steatorrhea, malnutrition, and weight loss are common symptoms of the disease; however, it is usually mild to moderate postgastrectomy. This article
reports a
case of EPI manifested by hypoalbuminemia leading to dyspnea and
anasarca, which are not typical symptoms of postgastrectomy EPI. A 61-year-old man with a history of gastric adenocarcinoma treated by total gastrectomy and chemoradiotherapy was admitted to the hospital with dyspnea and
anasarca. Despite being diagnosed as a
case of malignancy recurrence in another hospital, based on the symptoms described, no evidence of malignancy was found. His ascites and pleural effusion were determined to be caused by hypoalbuminemia. In addition, he claimed steatorrhea, and his stool elastase was lower than expected. EPI was diagnosed based on his medical history, paraclinical tests, and examinations. He remained asymptomatic for 1 year after being treated with albumin and pancreatic enzymes. Postgastrectomy EPI may be severe enough to cause steatorrhea or hypoalbuminemia. Hence, regardless of the severity of the presentation, physicians must be alert for this diagnosis throughout the follow-up of patients with a history of gastrectomy. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed.