DUMPING

SYNDROME
After patients have recovered from surgery
and begin to eat food in greater volume and
variety, they may experience increasing
discomfort following meals. About 10-15
minutes after eating, cramping and a full
feeling occur. The pulse is rapid, and there
is a wave of weakness, cold sweating, and
dizziness. Frequently, nausea and vomiting
occur. Such distressing reactions to food
intake increase anxiety, so the person eats
less and less. Weight loss and increasing
malnutrition follow.
 This postgastrectomy complex of
symptoms is commonly called the
DUMPING SYNDROME (also called
the jejunal hyperosmolar
syndrome). This difficulty is more
likely to occur in patients who
have total gastrectomy. The
symptom of shock result when:
 FIRST SEQUENCE

a meal containing a high proportion of readily soluble

carbohydrate ( a concentrated hyperosmolar solution in
relation to the surrounding extracellular fluid)
rapidly enters the jejunum (which
has been attached to the esophagus

Water is drawn from the blood into the intestine in order

to achieve osmotic balance = rapid decrease in the
circulating blood volume
resulting to

BP drops, and signs of cardiac insufficiency occur: rapid

pulse, sweating, weakness, and tremors
 SECOND SQUENCE (after 2 hours)

concentrated solution of simple carbohydrate is

rapidly absorbed

causing a


postprandial rise in blood glucose

resulting to


overproduction of insulin which in turn leads to
an eventual drop in blood sugar below normal
fasting levels= symptoms of mild hypoglycemia
result
 Dramatic relief of these distressing
symptoms and gradual regaining of lost
weight follow careful control of the diet.
Carbohydrate intake, especially simple
sugars, is kept to a minimum to prevent
rapid passage of food and formation of a
concentrated hyperosmolar solution.
Protein and fat are increased to provide
tissue-building material and retard
emptying of the food mass into the large
intestine. Meals are small, frequent, and
dry, with fluids between meals. There is less
bulk to stimulate motility and less water for
rapidly forming nutrient solutions.
Diet for Postoperative Gastric Dumping Syndrome
General Description
5 or 6 meals daily
Relatively high fat content to retard passage of
food and help maintain weight
High protein content (meat, egg, cheese) to
rebuild tissue and maintain weight
Relatively low high carbohydrate content to
prevent rapid passage off quickly used foods
No milk; no sugar, sweets, or desserts; no alcohol
or sweet carbonated beverages
Liquids between meals only; avoid fluids at least
1 hour before and after meals
Relatively low-roughage foods; raw foods as
tolerated
Preoperative Nutrition:
Emergency Surgery
 In an adequately nourished preoperative
patient with a normal energy and nitrogen
balance, a preoperative diet same as those
of an elective surgery may be followed. An
NPO (nil per os) instruction is also
implemented during the immediate
preoperative period.
In nutritionally depleted, stressed patient
with lacking energy and protein stores,
parenteral nutrition is given to somehow
replenish the stores for the upcoming
surgery. IV therapy may also be given to
provide fluid, carbohydrates and minerals to
the body before the operation.
For emergency surgery, when the patient is not fasted, or
in cases where doctors expect there to be stuff in the
stomach (bowel obstructions or pregnant women, for
example), they first see if they can do the surgery with a
technique other than general anesthesia. An awake patient
isn't going to aspirate. If that's not possible, they do a
rapid sequence induction with Sellick's maneuver and
intubate as quickly as possible. That means that fast
acting drugs are given very quickly, and pressure is
applied to the neck to press the tracheal rings against the
esophagus to (hopefully) prevent passive regurgitation of
stomach contents. Then they pass a good sized tube
through the nose or mouth into the stomach and suck out
whatever is lurking in there- GASTRIC LAVAGE.