Dumping Syndrome

Q) Late dumping syndrome is due to 

a) Insulin overshoot

b) Food bolus in jejunum

c) Release of serotonin

d) Local enteric reflexes


a, Excessive release of Insulin 

Dumping syndrome are most common after billroth II gastrectomy followed by BI and Truncal vagotomy and gastro jejunostomy.

Dumping can occur 30 mins after food, (early dumping) or 2 hours after eating (late dumping). Early dumping has GI symptoms such as nausea, vomiting, epigastric fullness, diarrhea and abdominal pain.

Early dumping occurs due to rapid emptying of chyme in jejunum. This hyperosmolar fluid draws water from extracellular compartment to the lumen of small intestine causing intestinal distension and autonomic changes.Serotonin, bradykinin-like substances, neurotensin, and enteroglucagon are involved in early dumping.

Late dumping syndrome  has more cardiovascular symptoms such as palpitations, light headedness, dizziness, tachycardia, diaphoresis, flushing and blurred vision.

It occurs due to delivery of carbohydrates into jejunum, their absorption causes hyperglycemia and insulin release. Excessive insulin release leads to development of symptoms.

Treatment of Dumping syndrome

  1. Diet - Avoid carbohydrates, frequent small meals of protein and fat and separate liquids from solids
  2. Octreotide agonists
  3. surgery Conversion to Roux en Y

Ref Sabiston 1212


Siewert classification for GE junction tumors

Q) According to Siewert classification tumors at GE junction are

a) Type I

b) Type II

c) Type III

d) Type IV

Answer (free for all)

Answer b

Type I   Lower  (centre located within between 1-5cm above the anatomic OGJ)

Type II Real GE junction  (within 1cm above and 2cm below the OGJ)

Type III  (2-5cm below OGJ)

This classification has only 3 subtypes

According to the Siewert-Stein classification,

Type I tumour 25% approx

Type II - Most common 49%

Type III was present in 25%

This classification helps in deciding the operative management and unified pre op classificationT

Types of Surgery

Type I cancer--depending of the size of the tumour--distal 2/3 oesophagectomy with the resection of the proximal lesser curve of the stomach or total gastrectomy  or THE

In patients with types II and III cancers total gastrectomy


Choledochal cyst

Q) False about choledochal cyst is 

a) Type IV is also known as Caroli's disease

b) Type I choledochal cyst is the most common type

c) Type III is also called as choledochocele

d) Type II choledochal cyst is diverticular disease

Answer is for premium members

This question was asked in NEET this year and a similar question on choledochal cyst is already on the website for some time.

Choledochal cyst

Carbon Monoxide poisoning

Q. Carbon monoxide poisoning true is

a. It is having 10 times more affinity than oxigen
b. 60 percent is not deadly.
c. Concentration above 10% are dangerous and need observation
d. Concentration above 10% are dangerous and need treatment with pure oxigen
for more than 24 hours

Answer Free 


Option A: Affinity of CO for Hb is 200-250 times that of oxygen. It causes a conformational change in Hb molecule and reduces affinity of Hb for O2, shifting the oxyhemoglobin dissociation curve to the left.

Option B: Concentrations less than 10% are usually asymptomatic. Concentrations >60% are fatal. Arterial carboxyhemoglobin level must be obtained because pulse oximetry can be falsely elevated.

Option C: Concentrations above 10 per cent are dangerous and need treatment with pure oxygen for more than 24 hours. Administration of 100% O2 reduces the half-life of CO from 250 minutes in room air to 40 to 60 minutes on 100% oxygen.