Initial treatment for severe early dumping after gastrectomy is:
|B||Oral glucose for symptoms|
|D||Surgical conversion to Roux-en-y drainage|
a. The dumping syndrome is a post operative complication of the gastrectomy .
b. It can be early or delayed.
c. The dumping syndrome, characterized by light headedness, diaphoresis, palpitations, crampy abdominal pain and diarrhea.
d. Diarrhea is consequence of rapid movement of gastric content into the upper intestinal tract.
e. It is related to the ingestion of a high –carbohydrate meal.
f. Pyloric bypass or ablation appears to be the main contributor to this syndrome.
g. Dumping occurs when an osmotic load is delivered to the intestine, causing an influx of water, intestinal an influx of water, intestinal distension, and rapid transit of the pre-digested meal.
h. Neurohumoral mechanism is associated with the gastric emptying and to the dumping syndrome.
i. But understanding of this mechanism is still not very clear.
j. The medical therapy for the dumping syndrome consist of dietary management and somatostatin analogue (octreotide).
k. Often symptoms improve if the patient avoids liquids during meals, adding dietary fibres compounds at meal time may improve the syndrome.
l. If dietary manipulation fails the patient is started on octreotide, 100,g s/c twice day.
m. Octreotide ameliorates the abnormal harmonal pattern seen in patients with dumping syndrome.
n. It also promotes restoration of a fasting motility pattern in the small intestine.
o. The alpha-glucosidase inhibitors acarbose may be particularly helpful in ameliorating the symptoms of late dumping.
p. Truncal vagotomy also leads to the gastric emptying.
• It occurs immediately after meals (after 15-30 minutes)
• Dumping of hyperosmolar contents into the small bowel results in rapid fluid influx from the circulation into the gastrointestinal tract. This leads to acute intestinal distention and peripheral and splanchnic vasodilatation".
• This gives rise to vasomotor and abdominal symptoms: Epigastric fullness, sweating, light headedness, tachycardia, diarrhea.
• Symptoms can be ameliorated by lying down and saline Infusion.
• It is seen 2-3 hrs after meal
• Occurs due to reactive hypoglycemia
• The carbohydrate load in the small bowel causes a rise in plasma glucose, which in turn, causes high insulin levels leading to hypoglycemia.
• Symptoms are relieved by administration of sugar.