A 43-year-old Chinese-American man comes to the office. He is complaining of diarrhea, cramping abdominal pain, postprandial nausea and vomiting for the past five days. He also has dizziness, generalized sweating, and shortness of breath. He had a partial gastrectomy for a bleeding gastric ulcer one month ago. He has smoked one pack of cigarettes a day for twenty years, and quit two months ago. He does not use alcohol or drugs. The patient is a food handler. His medications are omeprazole and antacids. Examination reveals a mildly distended abdomen with increased bowel sounds. The epigastrium is mildly tender, and the postsurgical scar is healing well. Which of the following will be the most appropriate therapeutic intervention?

Question

A 43-year-old Chinese-American man comes to the office.  He is complaining of diarrhea, cramping abdominal pain, postprandial nausea and vomiting for the past five days.  He also has dizziness, generalized sweating, and shortness of breath.  He had a partial gastrectomy for a bleeding gastric ulcer one month ago.  He has smoked one pack of cigarettes a day for twenty years, and quit two months ago.  He does not use alcohol or drugs.  The patient is a food handler.  His medications are omeprazole and antacids.  Examination reveals a mildly distended abdomen with increased bowel sounds.  The epigastrium is mildly tender, and the postsurgical scar is healing well.  Which of the following will be the most appropriate therapeutic intervention?

Quizplus · Accepted Answer

Explanation: The patient has dumping syndrome, a complication of gastrectomy. Liquid and food passage through the stomach into the jejunum is faster. This leads to abdominal pain, diarrhea, nausea and vomiting, as well as some neurovegetative symptoms such as dizziness, generalized sweating, and dyspnea. A change in the diet usually relieves the symptoms. A high protein diet, and fractionated, smaller, but more frequent food portions are advised. (Choice D)The diet should be low (not rich) in carbohydrates. (Choice A)Metoclopramide stimulates the contraction of the lower esophageal sphincter and increases gastric emptying. It may worsen the symptoms. (Choice C)A low-fiber diet may improve the diarrhea, but will not control the other features of dumping syndrome. (Choice E)Alprazolam is helpful for neurovegetative (not digestive) symptoms. Educational Objective: Dumping syndrome is a common complication of gastrectomy. Treatment is aimed at decreasing the speed of the passage of fluids and food into the small gut. A high-protein and low-carbohydrate diet is advised, as well as smaller but more frequent meals throughout the day.

A 43-Year-Old Chinese-American Man Comes to the Office