All of the following occur after highly selective vagotomy EXCEPT
|A||Basal acid secretion is reduced|
|B||Basal gastrin production is decreased|
|C||Liquids pass more rapidly into the duodenum|
|D||Solids pass into the duodenum at a normal rate|
a. Traditionally, liquid emptying has been attributed to the activity of the proximal stomach, but it is probably more complicated than previously thought.
b. Clearly, receptive relaxation and gastric accommodation play a role in gastric emptying of liquids.
c. Patients with a denervated (e.g., vagotomy), resected, or plicated (e.g., fundoplication) proximal stomach have decreased gastric compliance and may show accelerated gastric emptying of liquids.
d. A swallowed liquid meal induces receptive relaxation, but the same meal delivered via nasogastric tube bypasses this reflex and is associated with a higher intragastric pressure and accelerated emptying.
e. Normally, the half-time of solid gastric emptying is about 2 hours.
f. A linear emptying phase follows, during which the smaller particles are metered out to the duodenum.
g. Solid gastric emptying is a function of meal particle size, caloric content, and composition (especially fat).
h. When liquids and solids are ingested together, the liquids empty first.
i. Liquids also are sequestered in the fundus, but they appear to be readily delivered to the distal stomach for early emptying.
j. After vagotomy, gastric emptying is delayed. This is true for both truncal and selective vagotomies but not in the case of highly selective or parietal cell vagotomy.
k. With selective or truncal vagotomy, patients lose antral pump function and therefore have a reduction in their ability to empty solids.
l. In contrast, emptying of liquids is accelerated because of loss of receptive relaxation in the proximal stomach, which regulates liquid emptying.