<prompt> What is not true about dumping syndrome -Presence of hyper-osmolar content in the small bowelPresence of hypo-osmolar content in the small bowelOccurs due to the destruction of the pyloric sphincterNone  <response>: Ans. is B o Dumping syndrome refers to a constellation of post-prandial symptoms occuring due to accelerated emptying dumping of hyperosmolar stomach contents into the small bowel o It is usually seen in operation which destroy the pyloric sphincter i.e. gastrectomy, antrectomy and drainage procedures. It also affects a small percentage of patients with highly selective vagotomy due to loss of receptive relaxation of stomach. o It is of 2 types : a Early dumping syndrome It occurs immediately after meals after about 15 to 30 min Dumping of hyperosmolar contents into the small bowel results in rapid fluid influx from the circulation into the gastrointestinal tract. This leads to acute intestinal distention and peripheral and splanchnic vasodilation. This gives rise to vasomotor abdominal symptoms : epigastric fullness, sweating, light headedness, tachycardia, diarrhoea. Symptoms can be ameliorated by lying down or saline infusion. b Late dumping syndrome It is seen late - 2 to 3 hrs after meal Occurs due to reactive hypoglycemia. The carbohyrate load in the small bowel causes a rise in plasma glucose, which in turn, causes high insulin levels. Hyperinsulinemia leads to hypoglycemia. Symptoms are relieved by administration of sugar, o Management Dietaryr managment Diet therapy is done to reduce jejunal osmolality Multiple small meals Food low in carbohydrate and rich in fat and protein are taken. Liquids during meals should be avoided. Somatostatin analogues octreotide Diet therapy is usually successful but if it fails, the patient is started on octreotide. Surgery Most of the patients improve with time, dietary management and Octreotide. Only rarely surgery is needed. Surgical procedures used to treat dumping are: o Pyloric reconstruction, takedown of gastrojejunostomy, interposition of a 10 cm reversed intestinal segment beftveen the stomach duodenum, conversion of Billroth II to Billroth I anastomosis, and conversion to Roux-en-Y-anastomosis. 