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
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.
- Diet - Avoid carbohydrates, frequent small meals of protein and fat and separate liquids from solids
- surgery Conversion to Roux en Y
Ref Sabiston 1212