Date: [DATE]
Patient: [Patient Name]
MRN: [Medical Record Number]
Subjective:
Describe the characteristics of dumping symptoms:
Timing (early – within 30 minutes after eating, or late – 1-3 hours after eating)
Frequency and severity of episodes
Specific symptoms (nausea, vomiting, abdominal cramps, diarrhea, sweating, lightheadedness, palpitations)
Impact on daily activities and quality of life
Inquire about dietary habits, including meal size, frequency, and consistency.
Ask about any recent changes in symptoms or triggers identified.
Objective:
Vital Signs: Include heart rate, blood pressure (may be postural – check lying and standing BP).
Physical Exam:
Abdominal: Assess for distention, borborygmi (increased bowel sounds), and palpable tenderness.
Signs of dehydration (dry mucous membranes, poor skin turgor) if frequent vomiting is present.
Assessment:
Dumping syndrome (early or late) based on clinical presentation and timing of symptoms after meals.
Severity of dumping syndrome (mild, moderate, severe) based on frequency and intensity of symptoms.
Consider potential contributing factors:
Type of surgery (e.g., gastrectomy, gastric bypass)
Dietary habits (large meals, high sugar content)
Plan:
Dietary Management:
Recommend smaller, more frequent meals throughout the day.
Advise on low-carbohydrate, low-sugar diet with increased protein and complex carbohydrates.
Encourage slow, chewing food thoroughly.
Discuss avoiding foods/drinks known to trigger symptoms (e.g., sugary drinks, fatty foods).
Consider referral to a registered dietitian for personalized dietary counseling.
Medications:
Consider medications to help manage symptoms:
Acarbose: Delays carbohydrate breakdown in the intestines
Octreotide: Reduces intestinal secretions
Anti-emetics: For nausea and vomiting
Discuss potential side effects and benefits of each medication.
Non-pharmacological Management:
Encourage staying hydrated by sipping fluids throughout the day (avoid large volumes with meals).
Recommend lying down or resting for 30 minutes after meals to help slow stomach emptying.
Advise on wearing loose-fitting clothing to avoid abdominal discomfort.
Follow-up:
Schedule a follow-up visit to monitor response to dietary changes and medications.
Discuss the importance of long-term dietary management.
Consider referral to a bariatric surgeon if conservative measures fail to control symptoms and the patient has significant weight loss or malnutrition.
Note: This is a template and should be adapted to the specific patient encounter. Document all relevant details regarding symptoms, timing, severity, potential triggers, and treatment plan. Individualize dietary recommendations and consider surgical consultation for severe cases.