Nutritional Disturbances Associated with Diseases of the Stomach and Duodenum*

0 T view surgica1 Iesions of the stomach and duodenum from the standpoint of etioIogy, symptoms and signs, pathoIogy, and operative correction is to miss much. AItered physioIogy and biochemistry are aIso important and the surgeon of today has broadened his fieId to understand and correct the deficiencies resuIting from nutritional disturbances. These deficiencies may be associated with the vitamins, mineraIs, proteins, carbohydrates and fats, either individuaIIy or in combination. CaIoric requirements cannot aIways be entirely provided for, but even with compIete pyloric obstruction, energy for many days is obtained since the body oxidizes its own tissues. The parentera administration of gIucose is a distinct aid in preventing ketosis; actuaIIy sufficient gIucose can be given to maintain the gIycogen reserves of the body at a fair IeveI. However, the substances that can be administered in quantities by the intravenous channeIwater, gIucose and sodium chIoride-are inadequate by themselves to maintain health for more than two or three weeks. Vitamins and proteins’ are aIso needed and these requirements are often a considerabIe probIem for the seriousIy il1 patient. For many of them the period of maInutrition has existed for months before the operation, and a Iong-standing deficit is present. The purpose of this paper is to review briefIy the vitamin and protein deficiencies as they may affect the surgical patient with a Iesion of the stomach or duodenum. trace in deficiency disease, in which he pointed out that disturbances in digestion and absorption, as by vomiting, diarrhea or dysentery, are in the north temperate regions a more frequent cause of deficiencies than inadequate composition of the diet. McCoIIum,2 in 1937, summarized the recent advances in nutritiona research and Youmans, at about the same time, stressed the recognition of the mild or early forms of deficiency, which must be much more common in many groups of seriousIy III surgical patients than is reaIized. This subject merits cIoser attention from the surgeon. Vitamin A. A case of night bIindness due to a nutritional deficiency associated with a gastrocoIic fistuIa was reported by WiIbur and Eusterman4 in 1934. The patient had had a gastroenterostomy for a duodena1 uIcer in Ig 19, and in 19x9 symptoms of jejuna1 uIceration appeared. Two years Iater, in 193 I, diarrhea from a gastrocoIic fistuIa began, and periods of night bIindness occurred. The four to six semi-soft stooIs daiIy contained undigested food particIes. FoIlowing operative cIosure of the fistulous connection the diarrhea and the night bIindness disappeared.