Dumping syndrome is due to -
Dumping syndrome refers to a constellation of post-prandial symptoms occurring due to accelerated emptying (dumping) of hyperosmolar stomach contents into the small bowel. It is usually seen in operation which destroys the pyloric sphincter (i.e. gastrectomy, antrectomy and drainage procedures). It also affects a small percentage of patients with highly selective vagotomy due to loss of receptive relaxation of the stomach. It is of 2 types Early dumping syndrome it occurs immediately after meals (after about 15 to 30 min) 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 & abdominal symptoms: epigastria fullness, sweating, light headedness, tachycardia, diarrhea. Symptoms can be ameliorated by lying down or saline infusion. b. Late dumping syndrome it is seen late - 2 to 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. Hyperinsulinemia leads to hypoglycemia. Symptoms are relieved by administration of sugar. Management 1) Dietary management diet therapy is done to reduce jejunal osmolality multiple small meals food low in carbohydrate and rich in fat and protein are taken. liquids during meals should be avoided. 2) Somatostatin analogues (octreotide) diet therapy is usually successful but if it fails, the patient is staed on octreotide. 3) Surgery Most of the patients improve with time, dietary management and Octreotide. Only rarely surgery is needed. Surgical procedures used to treat dumping are pyloric reconstruction, the takedown of gastrojejunostomy, interposition of a 10 cm reversed intestinal segment between the stomach & duodenum, conversion of Billroth II to Biliroth I anastomosis, and conversion to Roux-en-Y-anastomosis. Ref : Love & Bailey 24/e, p 1043
Diarrhoea
Presence of hypeonic content in small intestine
Vagotomy
Reduced gastric capacity
G.I.T