After surgery on the stomach, especially after resection, patients often develop certain post-operative complications, of which the leader is dumping syndrome.
According to statistics, similar postgastorezektsionnoe disorder occurs in 10-30% of patients. Mostly in women there are such forms of pathology that require surgical correction.
The concept of
Dumping syndrome is a pathophysiological condition that develops after gastric resection against a background of neurohumoral digestive disorders.
Chewed food does not have time to be fully processed in the stomach cavity, it is poisoned into the small intestine and is already absorbed there, which leads to the development of functional abnormalities.
Causes of the dumping syndrome
The development of the disease is caused by surgical manipulations on the stomach such as ectomy or resection, during which the part of the organ is removed, truncating its lobe.
Similar interventions are usually performed by persons who have a tumor or ulcerative abnormalities of the stomach.
The reason for the development of dumping syndrome is the too rapid supply of insufficiently digested food into the intestinal cavity.
Fast food passage and accelerated bowel movements lead to the deterioration of the gastrointestinal wall condition - they stretch, lose the vascular fluid and the necessary bioactive components. As a result, smooth muscle tissues relax, the peristalsis and volumes of circulating blood decrease.
Against the backdrop of gastrectomy leading to a lack of motor functions, dumping syndrome most often develops. There is a violation of the hormonal gastrointestinal balance, the control of the endocrine system for digestive processes is changing.
Classification of
The dumping syndrome has several classifications: in terms of development time, severity, etc. At the time of development, the pathology is divided into:
- Early dumping syndrome - occurs immediately after eating against liquid and too carbohydrate food,milk consumption;
- Late - occurs a few hours after eating.
With an early dumping syndrome, further ingestion of food causes a worsening of the condition, in order to alleviate it somehow, the patient has to take a horizontal pose.
Accelerated emptying of the gastric cavity causes an increase in the amount of carbohydrate components ready for absorption in the small intestine, so a rapid rise in glucose level occurs. At once to process into glycogen the organism does not have time, therefore hyperglycemia of short-term type develops.
As a result of increasing the level of glucose, pancreatic excitation occurs and insulin production increases, at which the blood sugar level falls, causing hypoglycemia.
In terms of severity, the dumping syndrome can be divided into the following categories:
- Light degree - the attack lasts about half an hour, is accompanied by a weak clinical picture, worries several times a month.
- Medium degree - the attack is more pronounced, causes the patient to take a horizontal posture, lasts about an hour, the frequency of seizures is several cases per week.
- Severe degree - an attack lasts up to 3 hours, bothers the patient every day, the picture is pronounced, a pathological reaction occurs on absolutely any food.
Symptoms of the dumping syndrome
The clinical picture of the dumping syndrome is characterized by gastrointestinal and vasomotor symptoms.
With an early syndrome, the exacerbation occurs immediately after a meal. The patient experiences dizziness and weakness, headaches and cardial manifestations, fever and hot flashes, hypertension, etc.
In the epigastrium, severe pain, flatulence and vomiting, colic and diarrhea begin.
Diagnostics
Diagnosis of pathology is a complex exercise combining laboratory studies, contrast radiography and anamnestic analysis.
To determine the severity of the dumping syndrome, a provocative test with glucose is performed. To do this, the patient is given a glucose solution, and when the attack begins, they make the necessary measurements.
To assess the nature of functional and anatomical changes in the gastrointestinal structure, an X-ray examination using a contrast agent is prescribed. And to identify various abnormalities laboratory tests of urine, blood, feces etc.
are prescribed. Quality of life disorders in severe forms of the syndrome often lead to neuropsychiatric disorders, which also require correction.
Treatment of
An easy degree of the syndrome is treated with appropriate diet therapy, although in general conservative and surgical techniques can be used in treatment.
The conservative approach to therapy is justified for mild severity of the syndrome and involves the following measures:
- Substitution therapy - aimed at compensating for pancreatic and gastric secretion, involves the use of drugs like Insulin and glucose, the enzymatic components of the pancreas or stomach.
- General restorative treatment is aimed at stabilizing the condition of patients with electrolyte disorders, hypovitaminosis, anemia, etc. Vitamin complexes, blood transfusion, infusion infusion of saline solutions, etc. are indicated.
- Sedative treatment involves the use of hypnotics and antipsychotics, tranquilizers and antidepressants for the purpose ofrelief of neuropsychiatric and vegetovascular disorders.
- Diet therapy - properly formulated diet will reduce the severity and even avoid the onset of an attack.
- Auxiliary treatment - its goal is to restore motor-evacuation GIT functions, eliminate manifestations of dumping attacks. Prescribed drugs like Atropine, Insulin, anesthetics and antispasmodics, hormones and antihistamines.
- For the general strengthening of the body, physiotherapy such as electrosleeping is useful, and electrostimulation is shown to slow the processes of gastric emptying.
- In the development of severe neuropsychiatric disorders, the principles of psychotherapeutic treatment are applied.
- With a severe degree of syndrome, anabolic, ganglionic and corticosteroid medications are recommended, parenteral nutrition.
Food
Diet therapy with dumping syndrome is of great importance. Dietary nutrition program is made individually, although there are some general principles.
- A varied diet containing high-calorie, vitamin-rich and protein-rich foods, chemically and mechanically sparing for gastrointestinal structures.
- Fractional meals up to 5-7 times per day.
- Strong fish and meat broths, hot food, mushrooms, fried and fatty, spicy and smoked, rich and too cold food are forbidden. You can not mix any alcohol, chocolate, unprocessed raw vegetable crops, black bread, mushroom broths, etc.
- It is necessary to combine the reception of dense food with liquid, so try to take a drink with each serving while chewing.
- You can mash potatoes and yesterday's bread, cabbage and tomatoes, carrots and cucumbers, vinaigrette and a variety of salads, rassolniki and soup, borsch and okroshka. It is also permitted to eat dough cutlets, buckwheat and kefir, citrus fruits and dried fruits with dumping syndrome.
- Identify professionals and products that are poorly digested. They include butter and milk, fatty meat and yogurts, yolks, lard and rice porridge, grapes, bananas, etc.
Sweet dishes provoke a sudden attack, fatty diarrhea and bile vomiting, and apples and milk dishes - bloating.
It is necessary to plan the diet so that during the recovery period after surgery, you will not categorically prevent weight loss.
Complications of
Common complications of dumping syndrome are such conditions as hypoglycemia, anemia, electrolyte imbalance.
In a number of clinical cases, the pathology was accompanied by pathological transformations such as adhesions in the abdominal cavity, biliary dyskinesia, chronic pancreatitis and enteritis, peptic ulceration, etc.
Usually complications of the syndrome occur against the background of eating disorders and neglect of medical recommendations.
Prognosis and prevention
The development of the syndrome occurs in the first six months after resection. If the syndrome is poorly expressed, then the predictions are not bad, but with progressing or severe dumping syndrome, a disability soon develops.