Metabolic Disturbances After Gastric Surgery

1.

2.

Introduction
Definition: Metabolic disturbances after gastric surgery are abnormalities
in nutrient absorption, digestion, and metabolism that develop following
surgical procedures involving the stomach.

3.

causes ?
● Reduced gastric capacity
● Reduced secretion of hydrochloric acid and intrinsic
factor
● Altered gastrointestinal anatomy
● Impaired digestion and absorption of nutrients
● Reduced food intake and changes in gastrointestinal
motility

4.

Stomach operations

5.

6.

7.

Metabolic bone disease
MechanismsDecreased intake and intestinal absorption of calcium and vitamin D.
Insufficient calcium availability in the body.
Increased parathyroid hormone (PTH) production.
Enhanced breakdown of bone tissue.
Progressive reduction in bone mineral density.
ConsequencesOsteomalacia: Soft bones associated with bone pain and proximal muscle
weakness.
Osteoporosis: Weak bones with a higher risk of fractures.
These complications may develop several years after surgery.
PreventionAdequate calcium and vitamin D supplementation.
Regular bone mineral density assessment using DEXA scans.
Regular weight-bearing and resistance exercises.
Periodic monitoring of calcium, vitamin D and PTH levels.

8.

Anaemia
1. Vitamin B12 Deficiency-
Increased MCV and hypersegmented neutrophils.
Low serum vitamin B12 with elevated methylmalonic acid.
Clinical features include glossitis, numbness and memory impairment.
Delayed treatment can cause permanent neurological damage.
2. Iron DeficiencyDecreased MCV, low ferritin and reduced transferrin saturation.
Symptoms include pallor, fatigue and spoon-shaped nails (koilonychia).
Iron absorption decreases due to reduced gastric acid secretion.
Vitamin C improves the absorption of oral iron.
3. Folate DeficiencyElevated MCV and hypersegmented neutrophils.
Low serum folate concentration.
Clinical manifestations include glossitis, fatigue and pallor.
Develops due to poor dietary intake and impaired nutrient absorption.

9.

Other Vitamin and Trace Element Deficiencies After
Gastric Surgery
1. Fat-Soluble Vitamins (A, E and K)These vitamins may be lost due to fat malabsorption (steatorrhoea).
Vitamin A deficiency: Night blindness and impaired vision in dim light.
Vitamin E deficiency: Peripheral neuropathy and muscle weakness.
Vitamin K deficiency: Easy bruising and increased bleeding tendency.
2. Thiamine (Vitamin B1) DeficiencyDevelops due to persistent vomiting, poor nutritional intake and intestinal bypass.
Can cause Wernicke encephalopathy characterized by:
Confusion.
Ataxia (impaired coordination).
Eye movement abnormalities.
Thiamine should be administered before glucose to prevent worsening neurological
complications.

10.

Electrolyte imbalances

11.

Treatment and Prevention After Gastric Surgery
1. Vitamin Supplementation
Administer vitamin B12 injections; lifelong replacement is required after total gastrectomy.
Provide daily multivitamin and folic acid supplements.
Give thiamine (vitamin B1) in cases of persistent vomiting or inadequate food intake.
Use water-miscible formulations of vitamins A, D, E and K in patients with fat malabsorption.
Supplement vitamin D to maintain an adequate 25-hydroxyvitamin D level.
2. Mineral Supplementation
Iron supplementation with vitamin C to improve absorption; use IV iron if oral treatment is ineffective or
poorly tolerated.
Calcium citrate is preferred because its absorption does not depend on gastric acid.
Divide calcium supplementation into separate doses and administer it separately from iron.
Provide zinc and copper supplements when laboratory tests confirm deficiency.

12.

3. Electrolyte and Fluid Management
Use oral rehydration solutions to restore fluid and electrolyte balance.
Correct potassium and magnesium deficiencies together when both are present.
Identify and manage the underlying cause of diarrhoea or vomiting.
Reintroduce food gradually after prolonged malnutrition to reduce the risk of refeeding
syndrome.
4. Nutritional Support
Arrange regular assessment by a dietitian.
Educate patients about appropriate food choices and nutritional supplements.
Encourage adequate protein and calorie intake.
5. Prevention
Establish a postoperative nutritional monitoring programme.
Prescribe supplements according to the type of gastric surgery performed.
Perform regular clinical examinations and laboratory investigations.
Arrange periodic nutritional assessment and dietitian follow-up.