Question of the Week # 459

459) A 56-year-old man comes to the clinic complaining of postprandial nausea, occasional vomiting, and abdominal pain. Upon further questioning, he describes intermittent diarrhea and cramps, as well as diaphoresis, palpitations, and flushing. Three months ago he underwent resection of the distal stomach and proximal duodenum and gastrointestinal reconstruction due to complicated peptic ulcer disease. Prior to the operation, he had similar abdominal pain but it was usually relieved, not worsened with eating. Vital signs and physical examination are unremarkable. The most appropriate next step in the management of this patient is which of the following?
A. Begin a trial of somatostatin
B. Counsel the patient about his diet
C. Determine the patient’s gastrin level
D. Order a CT scan of the abdomen
E. Schedule a repeat endoscopy

5 Responses

  1. E

  2. B is the answer
    Counsel the patient regarding his diet
    eat in small amounts.

  3. Is this dumping syndrome? Is the pain from overdistension of what is left of the stomach?

  4. is this dumping syndrome due to the gastric and duodenal resection for complicated peptic ulcer disease, can r/o confidently underlying malignancy such as gastrinoma

  5. counsel patient about diet, for dumping syndrome

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