Dumping syndrome

Dumping syndrome

Q. 1 Least chances of complication like dumping syndrome and diarrhoea are seen in the following condition:

 A Parietal cell vagotomy

 B

Truncal vagotomy & Gastrojejunostomy

 C

Antrectomy with truncal vagotomy

 D

Vagotomy with pyloroplasty

Q. 1

Least chances of complication like dumping syndrome and diarrhoea are seen in the following condition:

 A

Parietal cell vagotomy

 B

Truncal vagotomy & Gastrojejunostomy

 C

Antrectomy with truncal vagotomy

 D

Vagotomy with pyloroplasty

Ans. A

Explanation:

Vagal denervation of just the parietal cell area of the stomach is called parietal cell vagotomy or proximal gastric vagotomy.

The technique spares the nerves of Latarjet but divides all vagal branches that terminate on the proximal two thirds of the stomach. 

 
Parietal cell vagotomy appears to have about the same effectiveness as truncal or selective vagotomy for curing the ulcer disease, but dumping and diarrhea are much less frequent.

It is probably the procedure of choice for intractable and perforated duodenal ulcers and is relatively less useful for obstructing and bleeding ulcers.

The principal disadvantage is recurrent ulceration in about 10% of patients.
 
Ref: Doherty G.M., Way L.W. (2010). Chapter 23. Stomach & Duodenum. In G.M. Doherty (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.

 


Q. 2

Dumping syndrome occurs least with ‑

 A

Selective vagotomy

 B

Truncal vagotomy

 C

Highly selective vagotomy

 D

Syndrome occurs with all of the above commonly

Ans. C

Explanation:

Ans. is ‘c’ i.e., Highly selective vagotomy 

It is least seen with highly selective vagotomy because the motility of the stomach is least affected in highly selective vagotomy and is most common with gastrectomy.


Q. 3

Dumping syndrome is due to:

 A

Diarrhoea

 B

Presence of hypertonic content in small intestine

 C

Vagotomy

 D

Reduced gastric capacity

Ans. B

Explanation:

Answer is B (Presence of Hypertonic Contents in small intestine)

DUMPING SYNDROME refers to a syndrome of abdominal and vasomator symptoms which results from dumping of food stuffs with a high osmotic load, front the stomach, into the small bowel.

Loss of storage capacity of stomach and ablation, by pass or destruction of pylorus, results in rapid emptying of hyperostnolar chyme into duodenummm and small intestine. Extracellular fluid then shifts into the intestinal lumen to restore isotonicity resulting in decreased intravascular volume, which gives rise to the vasomotor symptoms. Note that while reduced gastric capacity contributes, option (b) is a more accurate answer.

Dumping Syndrome is actually of two types:

  • Early dumping syndrome (as described above)
  • Late dumping syndrome: This is Reactive hypoglvcemiae. The carbohydrate load in thesmall intestine later causes a rise in plasma glucose, which in turn causes insulin levels to rise causing a secondary hypoglycemia.

Q. 4 Which, of the following plays a major role in the development of dumping syndrome:       

March 2009

 A Vagolytic mechanism

 B

Smaller stomach

 C

Excessive food in the stomach

 D

Large volume of hyperosmotic fluid in the intestine

Ans. D

Explanation:

Ans. D: Large volume of hyperosmotic fluid in the intestine


Q. 5

Dumping syndrome is characterized by all of the following except:

March 2005

 A

Colic

 B

Tremors and giddiness

 C

Hyperglycemia

 D

Epigastric fullness 

Ans. C

Explanation:

Answer- 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.

The vasomotor symptoms comprise general weakness, pallor, sweating, palpitation and light headedness.

symptoms of gastrointestinal disturbance such as epigastric discomfort, nausea, vomiting and possibly an episode of diarrhea is observed.

The biochemical changes that occur in dumping syndrome are hyperinsulinaemia followed by hypoglycaemia



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