整理一下 根據Washinton manual of surgery 3ed 2002 Dumping syndrome is thought to result from the rapid emptying of a high osmolar carbohydrate load into the small intestine, caused by the loss of reservoir capacity (due to vagotomy or resection) and the loss of pylorus function (by resection or pyloroplasty), and occurs most commonly after Billroth II reconstruction. ＊Early dumping occurs within 30 minutes of eating and is characterized by nausea, epigastric distress, explosive diarrhea, and vasomotor symptoms (dizziness, palpitations, flushing, diaphoresis). It is presumably caused by rapid fluid shifts in response to the hyperosmolar intestinal load and release of vasoactive peptides from the gut. ＊Late dumping symptoms are primarily vasomotor and occur 1-4 hours after eating. The hormonal response to high simple carbohydrate load results in hyperinsulinism and reactive hypoglycemia. Symptoms are relieved by carbohydrate ingestion. ＊Treatment is primarily nonsurgical and results in improvement in all but 1% of patients over time. Meals should be smaller in volume but increased in frequency, liquids should be ingested 30 minutes after eating solids, and simple carbohydrates should be avoided. Use of the long-acting somatostatin analogue octreotide results in significant improvement and persistent relief in 80% of patients when behavioral modifications fail. If reoperation is necessary, conversion to Roux-en-Y gastrojejunostomy is usually successful. Other surgical options include conversion to Billroth I (gastroduodenostomy) and jejunal segment interposition. =>由此可知,題幹敘述比較符合Early dumping syndrome,因此應從飲食少量多餐著手,再 不行可以使用long-acting somatostatin analogue octreotide,加上病患也無 發燒或是其他Infection的sign,因此不認為可以給抗生素,這也不是dumping syndrome所 建議的治療法,因此建議本題一律給分 --

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