[Verse 1] Postgastrectomy physiology, let's dissect the case Early dumping hits within an hour, hyperosmolar race Undigested carbs flood the jejunum, fluid shifts occur Osmotic pull draws plasma out, the blood pressure starts to blur Tachycardia, nausea, cramping — that's the autonomic flare Vasomotor symptoms, flushing, dizziness right there Late dumping comes at two to three hours, different mechanism though Rapid glucose absorption spikes, then insulin brings it low Reactive hypoglycaemia — the rebound is the threat Manage both with small dry meals, low glycaemic diet set Acarbose blocks late dumping's surge, octreotide for severe Lying flat post-meal for early — that's the intervention clear [Chorus] Early osmotic, late glycaemic — know the difference cold Terminal ileum, bypass, gastrectomy — predict what's lost Short bowel syndrome, length and anatomy control the toll Run the gut mechanics, surgical self-assessment is the goal Early osmotic, late glycaemic — etch it in your cortex fold [Verse 2] Terminal ileal resection — now which nutrients take the blow B12 absorption lives exclusively there, intrinsic factor can't bestow The enterohepatic circuit for bile salts cycles through that zone Resect it and the bile acids spill to colon, all alone Fat malabsorption follows, ADEK vitamins depleted fast Oxalate gets absorbed in excess — kidney stones forecast Over a hundred centimetres lost, bile acid pool's exhausted Cholestyramine won't suffice when that much tissue's costed Diarrhoea becomes secretory, steatorrhea takes hold Monitor your B12, your fat-soluble levels, zinc and folate bold [Chorus] Early osmotic, late glycaemic — know the difference cold Terminal ileum, bypass, gastrectomy — predict what's lost Short bowel syndrome, length and anatomy control the toll Run the gut mechanics, surgical self-assessment is the goal Early osmotic, late glycaemic — etch it in your cortex fold [Verse 3] Roux-en-Y gastric bypass, the biliopancreatic limb diverts Duodenum bypassed fully — iron and calcium absorption hurts Ferrous iron needs the acid bath the stomach used to give Now it bypasses that environment, deficiency's where you live B12 needs intrinsic factor meeting R-protein in the gut Pouch produces less intrinsic factor — that absorption's cut Thiamine, folate, vitamin D — monitor them all post-op Total gastrectomy takes it further, intrinsic factor stops No acid means no ionised iron, B12 requires injections now ADEK malabsorption, zinc deficiency — trace the why and how Quiddative losses accumulate — a sustained and subtle drain The body's nutrient reserves eroding, steady in their wane
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