Back to Topics<<<<

Dumping Syndrome
(Early Hyperglycemic Syndrome)


It is the prominent functional disturbances after the partial gasrectomy. It has mild intensity in 30% and severe intensity in 10%.

Pathogenesis:
If after gastric resection, there is evidence of large stoma between stomach and intestinal loop then food unsaturated with gastric juices moves quickly in the proximal part of intestine. As a result undigested food causes inadequate reaction with the mucous membrane receptors, leading to hyperosmolarity in the lumen of the intestines, where then the fluid migrates from the lumen of the intestine to the extracellular space. To achieve the osmotic equilibrium, there is evidence of release of biologically active substances such as histamine, serotonin, motiline etc. they cause the vasodilatation, decrease the plasma volume and increase the motor activity through the whole parameter of GIT.

Clinical Features:
Clinical features depend upon pathogenesis and include:
  • Weakness
  • Headache or light headedness
  • Tachycardia
  • Diaphoresis
  • Feeling of fullness
  • Pain in epigastrium
  • Palpitation and sometimes postural hypertension
Signs appear after 10 – 15 minutes after the ingestion of meals and are exaggerated with the milky and sugar foods due to high level of glucose in the blood as a result of biologically active substances, but precise mechanism is unclear.

For objective characteristic of Dumping Syndrome, arterial pressure, pulse rate, weight loss and results of treatment are used.
 
Grade I
Grade II
Grade III
Pain
 Pain occurs after carbohydrate foods Any food causes pain in the supine position Any food can cause the pain and the patient take horizontal position for 3-4 hours
Pulse
 Pulse rises up to 15 beats per minute Pulse rises more than 20-30 beat per minute Pulse rate is more than 30 beats per minute
Pulse Pressure
--
 Pulse pressure is mobile, slight elevation of systolic components Pulse pressure increase and there is evidence of high systolic and low
Duration
 15-30 minutes 45-60 minutes More than three hours
Weight loss
--
 10 kg More than 10 kg
Treatment
 Only by restriction to carbohydrate foods Sanitary/stationary treatment gives temporary relief Surgical only

Investigations:
X-rays reveal increased evaluation of the rate of barium enema or food from the stomach and show increased intestinal peristalsis. Radio opaque substance pass in small and large intestine five times faster than barium solution.

Provocation test:
50% of 150 ml of glucose solution

LATE OR HYPOGLYCEMIC SYNDROME


It is the clinical manifestation of hyperinsulinemia in the previous hyperglycemic syndrome and hypoglycemia occurs.

Clinical signs:
  • Weakness
  • Severe feeling of hunger
  • Empty stomach
  • Acute pain in epigastrium
  • Tremor in the extremities
  • High pulse rate
  • Low arterial pressure
  • Pale and dry skin
  • Dizziness
  • Confusion
  • Diaphoresis
Treatment:
Dietary:
Diet should be rich in proteins, low carbohydrates and normal levels of fat which should be eaten at normal temperature. Antihistaminic agents, Novocain is used for the quick dislocation of the food from the ventricle to the intestines.
Substitution therapy with gastric juices, HCl, pepsin, pancreatin, vitamins, calcium, magnesium and proteins is used.

Surgical repair:
Gastroduodenal anastomosis transformation to gastrojejunal anastomosis called “gastrojejunoduodenal plasty” is performed. After Billroth-II resection also gastrojejunoduodenal plasty is indicated, with truncal vagotomy for the prevention of inserted jejunal graft from peptic ulcers.

N.B. there is unique mechanism for hyper- and hypoglycemic syndrome and are interconnected i.e. we have to treat first hyperglycemic.

Back to Topics<<<<                            Top of this page^^^^
This article has been written by Dr. M. Javed Abbas.
If you have any comments please do not hesitate to sign my Guest Book.
00:27 08/02/2003