Name
DUMPING SYNDROME
DESCRIPTION
DETAIL
CAUSES Multifactorial including: β’ Rapid delivery of hyperosmolar material into intestine β’ Supraphysiologic release of various peptides/vasoactive mediators β’ Reactive hypoglycemia -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Mechanical obstruction β’ Gastroenteric fistula β’ Celiac sprue β’ Crohn disease β’ Pancreatic exocrine insufficiency β’ Neuroendocrine tumors (e.g., carcinoid) β’ Irritable bowel syndromeOTHER TESTS : * HISTORY OF OPERATION ( VAGOTOMY & DRAINAGE) IS TO BE TAKEN. LABORATORY β’ BLOOD SUGAR : Postprandial hypoglycemia β’ CBC : Anemia β’ SERUM ALBUMIN : Hypoalbuminemia IMAGING : β’ Upper GI series - barium rapidly emptying from stomach β’ Nuclear medicine gastric emptying study β’ Endoscopy (exclude mechanical obstruction)
TYPENOTES
RISK FACTORS Surgical drainage procedures, particularly gastrectomy; anti-ulcer surgeryGENERAL MEASURES : Dietary and medical management SURGICAL MEASURES : Surgery only if dietary and medical management unsuccessful and symptoms debilitating; variable results DIET : β’ Low carbohydrate β’ Frequent small meals with minimal liquid β’ Drink fl uids between meals only β’ High protein diet β’ Adequate caloric intake DRUG(S) OF CHOICE : β’ Octreotide (Sandostatin) 200-400 mcg/day subcutaneous, given in divided doses q8h. Can be very expensive. β’ Pectin/guar gum ALTERNATIVE DRUGS : Anticholinergics. Results generally disappointing PATIENT MONITORING : Follow to be sure of adequate nutrition PREVENTION/AVOIDANCE : β’ Eating frequent, small, dry meals that contain no refined carbohydrates β’ Restrict fluids to between meals POSSIBLE COMPLICATIONS : β’ Hypoglycemia β’ Malnutrition β’ Electrolyte disturbances including hypokalemia EXPECTED COURSE/PROGNOSIS : Favorable
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
SERUM PROTEIN TOTAL, BLOOD SUGAR ( AFTER MEALS ), COMPLETE BLOOD COUNT