Dumping syndrome
Contents:
Description:
Dumping syndrome — a disease which is a frequent complication of surgical interventions on a stomach, such as a stomach resection according to Billroth of I or vagisection with antrectomy. It is observed at 10-30% of patients.
Dumping syndrome symptoms:
Emergence of attacks of the general weakness is characteristic of a clinical picture of a dumping syndrome during reception of food or within the first 15-20 minutes after it. The attack begins with feeling of completeness in epigastriums and is followed by feeling of heat which spreads on an upper half of a trunk. Sharply sweating increases, there is an exhaustion, drowsiness, dizziness, a sonitus, trembling of extremities, deterioration in sight. These symptoms reach sometimes such intensity that the patient is forced to lay down. Losses of consciousness are sometimes observed, is more often in the first months after operation. Attacks are followed by tachycardia, sometimes short wind, a headache, paresthesias of upper and lower extremities, a polyuria or vasculomotor rhinitis. At the end of an attack or after a while after it patients often note abdominal murmur and a diarrhea.
Carbohydrate or milk food happens the most often provocative factor of a dumping syndrome. During the period between attacks patients complain of bystry fatigue, weakness, decrease in memory, working capacity, change of mood, irritability, apathy.
Dumping syndrome reasons:
Releaser of a dumping syndrome bystry transition of insufficiently digested, concentrated, preferential carbohydrate food from a stomach in intestines is considered. The inadequate chemical, physical and osmotic irritation of a mucous small bowel a chyme leads to sharp increase in a blood-groove in a gut. The last is followed by considerable redistribution of blood: blood supply of a brain, the lower extremities decreases, the blood stream in a liver increases. There is a hypovolemia that causes excitement of sympathoadrenal system and receipt in blood of catecholamines. In some cases excitement of a parasympathetic nervous system is possible that is followed by receipt in a blood stream of acetylcholine, serotonin, kinin in a blood stream.
In changes of motility of a small bowel at a dumping syndrome an important role is played by hormones of a small bowel. At height dumping reaction happens degranulation of endocrine cells of APUD-system and release of hormones of a motilin, neyrotenzin and enteroglyukagon.
Treatment of the Dumping syndrome:
1-2 Art. - are conservative
3 Art. – operational treatment (gastroyeyunoduodenostomiya)
Conservative therapy
1) Dietotherapy: meal of 6 times a day in the small portions. Separate use of liquid and firm food. At first – second course, in 30 minutes – the first. Food has to be not hot (not to accelerate evacuation). It is recommended in 30 minutes prior to meal – a glass of tomato juice to excite a hydrokinetic phase of secretion (pancreatic juice). To reduce amount of carbohydrates, to replace sugar with sorbite. To limit greasy food. After food to go to bed for 30 minutes.
2) Fortifying therapy
- glucose with insulin
- % B1 6 vitamin - 1 ml; B12 for 2000 гр / days;
- % B6 5 vitamin - 1 ml;
- niacin of 1% - ml.
- plasma transfusion, albumine, protein, albumine, erythroweight.
3) Replacement therapy: a natural gastric juice to or during food (1 tablespoon on 1/3 glasses of water), enzymes - pepsin, Pancreatinum, панзинорм, креон.
4) Sedative therapy: Elenium, Relanium, Seduxenum, Trioxazinum, aminazine, barbiturates
5) Delay of motility of 12 perstny guts: in 30 minutes prior to meal - 0,5 ml. 0,1% of solution of atropine subcutaneously
6) In case of a cachexia – corticosteroids, anabolic steroids
Surgical treatment
Indications to operation: a dumping syndrome of heavy degree in case of inefficiency of clinical nutrition and prolonged complex drug treatment.
Operative measure consists in a reduodenization from gastroyeyunoduodenoplastiky. The enteric transplant slows down emptying of a stump of a stomach, inclusion of a duodenum improves digestion and at a number of patients dumping reaction can reduce intensity.
