All are true about dumping syndrome except:
Ans: B (PPI is...) Early and late dumping L & B 26th/1039-40Although considered together because the symptoms are similar, early and late dumping have different aetiologies. A common feature, however, is early rapid gastric emptying.Many patients have both early and late dumping.Early dumping L&B26th/1039# It consists of abdominal and vasomotor symptoms that are found in about 10 per cent of patients following gastrectomy or vagotomy and drainage.The small bowel is filled wdth foodstuffs from the stomach, which have a high osmotic load, and this leads to the sequestration of fluid from the circulation into the gastrointestinal tract. This can be observed by the rise in the packed cell volume while the symptoms are present.The principal treatment is dietary manipulation. Small, dry meals are best, and avoiding fluids with a high carbohydrate content also helps.Fortunately, following operation, the syndrome tends to improve with time. For some reason, however, there is a group of patients who suffer intractable dumping regardless of any of these measures.The somatostatin analogue octreotide given before meals has been shown to be useful in some individuals and the long-acting preparation may also be useful.Revisions! surgery may be occasionally required.Late dumpingl&b26th/1039This is reactive hypoglycaemia. The carbohydrate load in the small bowel causes a rise in the plasma glucose, which, in turn, causes insulin levels to rise, causing a secondary' hypoglycaemia.This can be easily demonstrated by serial measurements of blood glucose in a patient following a test meal.# The treatment is essentially the same as for early dumping. Octreotide is very effective in dealing with this problem.Table( L & B 26th/1039): Features of early and late dumping EarlyLateIncidenceRelation to meals5-10%Almost immediate5%Second hour after mealDurations of attackReliefAggravated by Precipitating factor30-40 minutes lying downMore foodFood, especially carbohydrate-rich and wetFoodExerciseAs early dumpingMajor symptomsEpigastric fullness, sweating light headedness, tachyoardia, colic sometimes diarrheaTremor, faintness prostrationEarly form of dumping syndrome SaA/ston 19th/l203The early form of dumping syndrome usually occurs within 20 to 30 minutes after ingestion of a meal and is accompanied by both Gl and cardiovascular symptoms.The symptoms characteristically occur while the patient is seated at the table eating or shortly after eating.Although the exact sequence of events responsible for this syndrome remains to be fully defined, it is generally agreed that it occurs because of the rapid passage offood of high osmolarity from the stomach into the small intestine.Most patients subjected to gastric surgery7 complain of some dumping-like symptoms after surgery7. Most, however, experience spontaneous relief and require no specific therapy.In those situations in which symptoms are prolonged, dietary measures are usually sufficient. These dietary measures include avoiding foods containing large amounts of sugar, frequent feeding of small meals rich in protein and fat, and separating liquids from solids during a meal.Late Dumping Sabiston I9th/1203The syndrome of late dumping appears 2 to 3 hours after a meal and is far less common than early dumping. The basic defect in this order is also rapid gastric emptying; however, it is related specifically to carbohydrates being delivered rapidly into the proximal intestine.These patients should be advised to ingest frequent small meals and to reduce their carbohydrate intake. Some patients have found benefit with pectin either alone or in combination with acarbose, an a-glucoside hydrolase inhibitor that delays carbohydrate absorption through impairment of intraluminal starch and sucrose digestion.
Treatment consists of small meal at short interval
PP1 is very useful in treatment
Watery & carbohydrate rich food are precipitating factors
May occur after gastrectomy or vagotomy and drainage operations
Postgastrectomy Complications