Dumping syndrome is characterized by all of the following except: March 2005
Ans. C: Hyperglycemia Dumping syndrome is a relatively rare disorder in which the stomach contents are delivered too quickly to the small intestine. It occurs as a physiological reaction to the consumption of too much simple or refined sugar in some persons, when simple sugar exits the stomach too rapidly it attracts fluid into the upper intestine, and the blood volume decreases as it attempts to absorb the sugar. Dumping syndrome is one of the unwanted post operative sequelae to paial gastrectomy. This symptom complex is believed to be due to rapid emptying of the gastric contents into the upper small intestine and also an increased transit rate through the small bowel itself right through the colon. As a consequence of this dumping a large volume of hyperosmotic fluid enters the small intestine. In an attempt to bring the osmotic tension to the physiological range, large amount of fluid cross the intestinal mucosa. As a result the plasma volume is reduced, which in turn exes a vasomotor effect. The vasomotor symptoms comprise general weakness, pallor, sweating, palpitation and light headedness. Another set of symptoms of gastrointestinal disturbance such as epigastric discomfo, nausea, vomiting and possibly an episode of diarrhea is observed. The biochemical changes that occur in dumping syndrome are hyperinsulinaemia followed by hypoglycaemia due to rapid transpo and absorption of food from small intestine after a meal. Since the conversion of glucose to glycogen and its storage consumes potassium, its level in blood decreases in dumping syndrome and hence hypokalaemia may be seen too. These symptoms classically occur some 5-30 minutes after eating and are more marked if the meal is large paicularly if it contains a substantial amount of carbohydrate and liquid. The choices for managing dumping syndrome include dietary changes, medications and surgery. Although dumping syndrome classically develops after gall bladder surgery, it may also occur after other abdominal operations, such as duodenal ulcer surgery or surgery for severe reflux. Sometimes it may be seen in people born with unusually small stomach and very rarely in those with stomach abnormalities.
Colic
Tremors and giddiness
Hyperglycemia
Epigastric fullness