Pathophysiologic cause of these postprandial symptoms! - USMLE Forums
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  #1  
Old 07-26-2011
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GIT Pathophysiologic cause of these postprandial symptoms!

A 28-year-old morbidly obese patient undergoes surgery to drastically reduce his stomach volume. The surgery includes a gastrojejunostomy to bypass the pyloric sphincter. He is successful in losing 14 kg (30 lb) over the next 6 weeks. He eats a large meal on one occasion, and toward the end of the meal he experiences severe nausea, headache, and palpitations before fainting. Which of the following may have contributed to his postprandial symptoms?

A. Increased duodenal enterogastrone response
B. Increased secretion of enteric hormones
C. Reduced function of the ileal brake
D. Reduced insulin secretion
E. Reduced intestinal water flux
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  #2  
Old 07-26-2011
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C. Reduced ilieal brake - dumping syndrome.

Normally, the pyloric valve at the lower end of the stomach regulates the release of food into the bowel. When the Gastric Bypass patient eats a sugary food, the sugar passes rapidly into the bowel, where it gives rise to a reaction called dumping syndrome. The body will flood the intestines in an attempt to dilute the sugars. An affected person may feel their heart beating rapidly and forcefully, break into a cold sweat, get a feeling of butterflies in the stomach. Diarrhea may then follow

http://en.wikipedia.org/wiki/Gastric_bypass_surgery
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  #3  
Old 07-26-2011
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dumping syndrome? so, the right one should be B!
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  #4  
Old 07-27-2011
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i ll go wid c
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  #5  
Old 07-27-2011
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I think its B
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  #6  
Old 07-27-2011
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can smebody please elaborate the changes after gastrectomy + vagotomy
tht will b great help
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  #7  
Old 07-27-2011
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i''ll go with B
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  #8  
Old 07-27-2011
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Correct Answer Correct answer

The correct answer is B)

The patient is experiencing dumping syndrome. Rapid delivery of a meal into the small intestine increases the secretion of several gut hormones such as enteroglucagon, peptide YY, pancreatic polypeptide, vasoactive intestinal polypeptide, glucagon-like peptide, and neurotensin, which is believed to contribute to the symptoms.

A) This patient had a gastrojejunostomy, bypassing the duodenum. His duodenal “enterogastrone” response to provide feedback inhibition of stomach emptying is therefore missing.

C) The patient is experiencing dumping syndrome. Increased secretion of enteric hormones such as enteroglucagon, peptide YY, pancreatic polypeptide, vasoactive intestinal polypeptide, glucagon-like peptide, and neurotensin occur as a result of rapid movement of the meal into the small intestine. This represents increased activity of the ileal brake, a hormonal mechanism to reduce gastric emptying and proximal intestinal motility when premature delivery of nutrient to the distal small intestine occurs.

D) The patient is experiencing dumping syndrome. Rapid delivery of nutrients to the jejunum produces an incretin response, which stimulates insulin secretion.

E) The patient is experiencing dumping syndrome. Rapid delivery of osmotically active solids and liquids produces a large fluid shift into the small intestine. This may contribute to the patient’s symptoms.
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  #9  
Old 07-27-2011
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Idea! source

Bebix Can you please also post the Source of the questions with the explanations
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  #10  
Old 07-28-2011
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E. Reduced intestinal water flux
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