Let's take a look at Dumping syndrome. So if gastroparesis
is due to a functional immobility not an obstructive,
what's dumping? A complication of surgery during
resection of pylorus, which means what? Now, you have
highly osmolar substances in which there isn't enough
time or there is inadequate time of properly churning
your chyme and such in the stomach. So therefore it
quickly will dump the content of the stomach into the duodenum.
Osmolar food particles into the gut after a meal.
Supraphysiologic release of peptide and vasoactive mediators
with reactive hypoglycemia are things that you're
looking for with Dumping syndrome. Because you're hurriedly
dumping everything out. The body gets a little sensitive
and it wants to take care of the issues as quickly as possible.
So there is going to be not this slow sustained
controlled release of insulin. But with all of those
being dumped into the duodenum then at this point
understand that the triggers such as your GLP−1
and so on and so forth, are going to come in and
they're going to excessively release insulin.
So all your peptides and vasoactive are all coming
out very quickly. Dizziness, flushing, palpitations
and diaphoresis shortly after the ingestion of the
meal. It's actually quite stressful. Be able to
identify your symptoms. Surgery. Complication due to
resection of pylorus is one of your major causes.
So therefore with Dumping Syndrome, because it's
quite difficult, remember, once surgery takes place,
it's quite difficult to, to retract the issue and it's
quite difficult to come back to complete normalcy.
You just keep that in mind in general either on your
boards or on your wards or especially those of you
that are going into surgery. Once you perform the
surgery, everyone behaves a little bit differently.
For example, adhesions and so on and so forth.
So, everyone behaves a little bit differently.
So now with Dumping Syndrome because now you're
educating your patient over the long haul,
you may not be able to correct the dumping. So
therefore you tell the patient instead of having that
normal meals that they were having, maybe three times
a day or maybe they were just, you know, a stressful
job and they were just eating something really
quick, your recommendation: small frequent meals
with minimal liquid, low carbohydrate diet, drink
fluid between the meals only and high protein diet.
Now, obviously that has its own set of complications
but really you have to manage your patient accordingly.