Ans. is 'a' i.e., Reduction of part of stomach Dumping syndrome -o Symptom complex that occurs following ingestion of a meel wrhen part of stomach has been removed or the pyloric sphincter mechanism has been disrupted.o Dumping syndrome refers to a constellation of post-prandial symptoms occuring due to accelerated emptying (dumping) of hyperosmolar stomach contents into the small bowel.o It is usually seen in operation which destroy the pyloric sphincter (i.e. gastrectomy, antrectomy and drainage procedures). It also affects a small percentage of patients with highly selective vagotomy due to loss of receptive relaxation of stomach.o It is of 2 typesEarly dumping syndromeIt occurs immediately after meals (after about 15 to 30 min)Dumping of hyperosmolar contents into the small bowel results in rapid fluid influx from the circulation into the gastrointestinal tract. This leads to acute intestinal distention and peripheral and splanchnic vasodilation.This gives rise to vasomotor & abdominal symptoms : epigastric fullness, sweating, light headedness, tachycardia, diarrhoea.Symptoms can be ameliorated by lying down or saline infusion.Late dumping syndromeIt is seen late - 2 to 3 hrs after mealOccurs due to reactive hypoglycemia. The carbohyrate load in the small bowrel causes a rise in plasma glucose, which in turn, causes high insulin levels. Hyperinsulinemia leads to hypoglycemia.Symptoms are relieved by administration of sugar,o ManagementDietary managmentDiet therapy is done to reduce jejunal osmolalityMultiple small mealsFood low in carbohydrate and rich in fat and protein are taken.Liquids during meals should be avoided.Somatostatin analogues (octreotide)Diet therapy is usually successful but if it fails, the patient is started on octreotide.SurgeryMost of the patients improve with time, dietary management and Octreotide. Only rarely surgery is needed,Surgical procedures used to treat dumping arePyloric reconstruction, takedown of gastrojejunostomy, interposition of a 10 cm reversed intestinal segment between the stomach & duodenum, conversion of Billroth II to Billroth I anastomosis, and conversion to Roux-en-Y-anastomosis.