dumping syndrome
Introduction
Introduction Dumping syndrome refers to the loss of the pylorus or its normal function after gastrectomy and gastrojejunostomy due to surgery. The food in the stomach suddenly falls to the duodenum or jejunum, which can cause a series of symptoms. It can occur after any type of stomach surgery, and is more common after the Billroth II type of gastrectomy. The vagus nerve injury caused by esophageal surgery can also cause dumping symptoms. Late dumping syndrome is more than half a year after surgery, and symptoms of hypoglycemia appear 1 to 3 hours after a meal, such as weakness, hunger, palpitation, sweating, dizziness, anxiety, even confusion, and syncope. The vast majority of patients have early-onset dumping, or both early-onset and late-onset dumping. A small number of patients only show late fall.
Cause
Cause
Cause:
The beginning of the early dumping syndrome is due to the rapid entry of food into the small intestine, the migration of fluids into the gastrointestinal tract to maintain normal osmolality in the gastrointestinal tract, and hypovolemia leading to somatic symptoms. However, the mechanism of "high osmotic pressure theory" in the occurrence of dumping syndrome is also questionable because the amount of fluid that migrates is only 300-700 ml, and the acute loss of such a volume of liquid is usually easily tolerated. Hinshaw first reported the expansion of peripheral blood vessels when oral glucose induced dumping, rather than the shrinkage that was traditionally considered to be in a state of hypovolemia. Peripheral venous and splenic vein dilatation may be an important factor in the appearance of physical symptoms and signs during early onset. Some studies have shown the role of the serotonin and kinin-bradykinin systems in the onset of dumping, but the evidence is not compelling. After taking glucose, the patient's glucagon was significantly increased, and vasoactive intestinal peptide, YY peptide, pancreatic polypeptide and neurotensin also showed similar reactions. Late dumping syndrome is caused by reactive somatic hypoglycemia. Rapid food intake into the small intestine and rapid absorption of glucose lead to high insulin and hyperglycemia reactions, and high insulin causes secondary hypoglycemia.
mechanism:
1. A large amount of food directly enters the small intestine to expand and expand the intestinal tract. The hypertonic food sucks a large amount of body fluid from the intestinal wall in the small intestine and also expands and expands the intestinal tract.
2. The expansion of the intestine can cause a reflex response of the autonomic nerve, so that the intestinal wall releases serotonin, bradykinin, substance P, other intestinal vasoactive intestinal peptide, etc., resulting in increased intestinal peristalsis and vasodilation. The latter causes cyclical symptoms such as decreased blood pressure and increased heart rate.
3. Infiltration of extracellular fluid into the intestinal lumen can cause a decrease in effective circulating blood volume, a decrease in serum K, and an increase in symptoms of the circulatory system.
The food is empty faster when standing, and the above symptoms are more obvious. In short, the postprandial symptom group is a comprehensive response of the above three factors.
Examine
an examination
The diagnosis of dumping syndrome lacks objective criteria, and the diagnosis is based on detailed medical history data. Early dumping syndrome occurs more than 1 to 3 weeks after surgery. Symptoms appear within 1 hour after a meal, while asymptomatic occurs in fasted state. Fluids and foods rich in sugar are particularly difficult to tolerate. Symptoms The degree of severity varies, and clinical symptoms can be divided into systemic somatic symptoms and gastrointestinal symptoms. Systemic physical symptoms: dizziness, palpitations, tachycardia, extreme weakness, excessive sweating, trembling, pale or flushing, severe blood pressure, syncope; gastrointestinal symptoms: upper abdominal warmth, fullness discomfort, Nausea, vomiting, belching, bowel, diarrhea, and sometimes a sense of urgency. It usually lasts for about 1 hour and can be relieved by itself. Severely ill patients may lose weight due to fear of eating, often with malnutrition.
Some researchers have used simple oral glucose stimulation to induce dumping syndrome test: heart rate increased by 10 times/min or more within 1 hour after oral administration of 50g glucose for sensitivity (100%) and specificity (92%) for diagnosis of early-onset dumping syndrome. index. The hydrogen breath test reflects rapid migration into the distal ileum or colon after oral glucose, with a sensitivity of 100% and a lower specificity.
Diagnosis
Differential diagnosis
Because of the typical symptoms of fullness, sweating, tachycardia, and blood pressure drop after abdomen surgery, the patients are easily differentiated from hypoglycemia and hypotension caused by other causes.
