Dumping Syndrome

Q) Late dumping syndrome is due to 

a) Excessive release of insulin

b) Food bolus in jejunum

c) Release of serotonin

d) Local enteric reflexes

Answer

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. surgery Conversion to Roux en Y

Ref Sabiston 1212

 

Endovenous Laser Ablation of varicose veins

Q )  Endovenous Laser Ablation (EVLA)  of  varicose veins is best suited for those :

a) With needle phobia

b) Thrombophlebitis

c) Excess tortuousity

d) Primary varicose veins

Answer

EVLA is thermal ablation of varicose veins in which laser  fibre is inserted in the lumen and ablation is done from inside. It is a good modality for primary and recurrent varicose veins and work in both long and short segments.

This treatment is not effective in cases where there is needle phobia or the veins are having excessive tortuousity or thrombophlebitis. This procedure is done under ultrasound guidance and  wire is passed from the superficial to the deep veins.

Tumescent local anesthesia also helps

Ref Bailey: Page 909

Whipple’s triad

Q) Whipple's triad is seen in 

a) Insulinoma

b) Glucagonoma

c) VIPOma

d) Somatostatinoma

Answer 

a

Whipple's triad is seen in pancreatic insulinoma and consists of 

a) Symptoms of hypoglycemia

b) Fasting sugar less than 50 mg%

c) Relief of symptoms with administration of dextrose solution

  • Insulinoma is the most common functioning pancreatic neuroendocrine tumor
  • Symptoms are present for many years before diagnosis
  • Weight gain is common
  • Distribution of insulinomas is equal in body head and tail
  • Avg size of insulinoma is 1-1.5 cm