Stomach Disorders: Dumping Syndrome

Question 1

What is Dumping Syndrome?

Answer 1

• A condition that occurs when food is emptied (dumped) from the stomach into the small intestine too quickly

Question 2

When does dumping syndrome occur?

Answer 2

• Commonly seen after gastric surgeries

Question 3

What are the two phases for symptoms of dumping syndrome?

Answer 3

• Early: 10-30mins right after a meal
• Late: 1-3hrs after a meal

Question 4

What are the percentages of pts reporting early vs late dumping syndrome?

Answer 4

• 75% = early s/s
• 25% = late s/s

Question 5

What are the s/s of early dumping syndrome?

Answer 5

• N/V
• Gas
• Bloating
• Cramping

Question 6

What are the s/s of late dumping syndrome

Answer 6

• Hypoglycemia
• vertigo/syncope
• Pallor/Sweating
• Tachycardia/palpitations
• Diarrhea

Question 7

What causes N/V in dumping syndrome?

Answer 7

• Not enough capacity in stomach

Question 8

What causes vertigo and syncope w/ dumping syndrome?

Answer 8

• Blood flow prioritized to stomach, reducing flow to brain

Question 9

How does dumping syndrome result in hypoglycemia?

Answer 9

• The food passes before insulin can be produced and absorbed causing sugar to drop

Question 10

What diet changes can help slow gastric emptying and minimize dumping syndrome s/s?

Answer 10

• Eat freq, small meals that are chewed well or chopped up
• Limit concentrated sugars (cakes, pies, sweetened fruit juices, soft drinks)
• No artificial sweeteners (Splenda ok)
• No liquids w/ meals. 30 mins before and after
• Rest/lie down for 30mins after meal

Question 11

What are the diet composition guidelines for dumping syndrome?

Answer 11

• Every meal should contain
  
  • Complex carbs
  • High fiber foods
  • Small amount of extra fats
  • Protein

Question 12

What types of foods are high in fiber?

Answer 12

• Beans, lentils, fruits, vegetables, whole grains

Question 13

What types of foods are good for fats?

Answer 13

• Avocado, nuts and nut butter

Question 14

What types of foods are good for protein?

Answer 14

• Meat, poultry, fish, eggs, dairy, tofu, nut butters

Question 15

With dumping syndrome, what can artificial sweeteners cause?

Answer 15

• Diarrhea, gas, bloating

Question 16

Why are fruits that are high in pectin (peaches, apples, plums) helpful with dumping syndrome?

Answer 16

• It increases chyme viscosity and slows down gastric emptying/digestion

Question 17

What three vitamins are important to eat or take supplements for w/ dumping syndrome?

Answer 17

• Vit B12
• Iron
• Calcium

Question 18

Why would Octreotide (standostatin) be given to a pt with dumping syndrome?

Answer 18

• It is an antidiarrheal

Question 19

What medication can be given to manage hypoglycemia as a result of dumping syndrome and how does it work?

Answer 19

• Acarbose
• It works by slowing the action of certain chemicals that break down food to release glucose (sugar) into your blood.
• Slowing food digestion helps keep blood glucose from rising very high after meals.
• Allows insulin time to be released

Question 20

What is the nutritional therapy for postprandial hypoglycemia?

Answer 20

• Immediate ingestion of sugared fluid/candy
• Lower carb intake
• Moderate protein and fats

Question 21

What is Bariatric Surgery?

Answer 21

• Removal of part of the stomach to reduce of gastric capacity or absorption in morbidly obese patients
  
  • BMI >4, or BMI >35 w/ other risk factors

Question 22

What is a key bariatric post-op complication to monitor for?

Answer 22

• Monitor for dumping syndrome

Question 23

What is our pt teaching for bariatric surgery pts?

Answer 23

• Chew food slowly and completely
• Eat small freq meals
• Do NOT consume liquids with meals
• DO recline after meals to slow gastric emptying (with dumping syndrome)
• Keep diet low in sugar, fat and carbs
• Take vitamin/mineral supplements as directed

Question 24

What is a gastric balloon?

Answer 24

• Also known as an intragastric balloon or a stomach balloon
• It is an inflatable medical device that is temporarily placed into the stomach to help reduce weight (can also be used to stop bleeding).
• It is designed to help provide weight loss when diet and exercise have failed, and surgery is not wanted or not recommended for the patient.

Question 25

What is the normal capacity of the stomach?

Answer 25

• 1000-5000mL

Question 26

Bariatric surgery reduction can reduce stomach capacity to what range?

Answer 26

• 800-1000mL

Question 27

What are three common bariatric surgeries performed?

Answer 27

• Gastric pouch
• Gastric band
• Gastric sleeve

Question 28

Describe the gastric pouch.

Answer 28

• Stomach is split in two
• Small intestine is cut after jejunum with distal end being attached to the pouch and the proximal end sutured back on downstream to be able to deliver digestive juices

Question 29

Describe the gastric band.

Answer 29

• A silicone device placed around the upper section of the stomach, creating a small pouch above the band and thereby restricting the amount of food that can be comfortably eaten.

Question 30

Describe the gastric sleeve.

Answer 30

• Procedure that removes 75-80% of the stomach. It is now the most commonly performed bariatric procedure in world.