12-15-2007, 09:59 AM
The answer is C.
The patient's symptoms are consistent with bacterial overgrowth in the afferent loop. These
patients complain of abdominal bloating and pain 20 min to 1 h after eating. There may be
associated vomiting. In addition, malabsorptive diarrhea is common and ceases with fasting.
The report of foul-smelling diarrhea that floats should prompt an evaluation for fat
malabsorption. This patient also has a macrocytic anemia, which can result from vitamin B12
deficiency.
Many other complications have been noted after surgery for peptic ulcer disease. Dumping
syndrome refers to a spectrum of vasomotor symptoms that occur after peptic ulcer surgery,
including tachycardia, light-headedness, and diaphoresis. It can occur within 30 min of eating
and is related to rapid delivery of hyperosmolar contents to the proximal small intestine,
resulting in large fluid shifts. A late dumping syndrome can also occur, with similar symptoms
developing 90 min to 3 h after eating. It is related to meals containing large amounts of simple
carbohydrates and thus causes insulin surges and hypoglycemia. Bile reflux gastropathy
presents after partial gastrectomy with abdominal pain, early satiety, and vomiting. Histologic
examination reveals minimal inflammation but extensive epithelial injury. Treatment consists of
prokinetic agents and bile acid sequestrants. Finally, postvagotomy diarrhea occurs in 10% of
patients after peptic ulcer surgery. These patients usually complain of severe diarrhea that
occurs 1 to 2 h after meals. Abdominal bloating and malabsorption are not usually part of this
syndrome
The patient's symptoms are consistent with bacterial overgrowth in the afferent loop. These
patients complain of abdominal bloating and pain 20 min to 1 h after eating. There may be
associated vomiting. In addition, malabsorptive diarrhea is common and ceases with fasting.
The report of foul-smelling diarrhea that floats should prompt an evaluation for fat
malabsorption. This patient also has a macrocytic anemia, which can result from vitamin B12
deficiency.
Many other complications have been noted after surgery for peptic ulcer disease. Dumping
syndrome refers to a spectrum of vasomotor symptoms that occur after peptic ulcer surgery,
including tachycardia, light-headedness, and diaphoresis. It can occur within 30 min of eating
and is related to rapid delivery of hyperosmolar contents to the proximal small intestine,
resulting in large fluid shifts. A late dumping syndrome can also occur, with similar symptoms
developing 90 min to 3 h after eating. It is related to meals containing large amounts of simple
carbohydrates and thus causes insulin surges and hypoglycemia. Bile reflux gastropathy
presents after partial gastrectomy with abdominal pain, early satiety, and vomiting. Histologic
examination reveals minimal inflammation but extensive epithelial injury. Treatment consists of
prokinetic agents and bile acid sequestrants. Finally, postvagotomy diarrhea occurs in 10% of
patients after peptic ulcer surgery. These patients usually complain of severe diarrhea that
occurs 1 to 2 h after meals. Abdominal bloating and malabsorption are not usually part of this
syndrome