Gastric dumping syndrome differential diagnosis: Difference between revisions

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Revision as of 23:38, 28 November 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Umar Ahmad, M.D.[2]

Overview

Dumping syndrome may often be confused with other similar diseases that cause upper abdominal pain, nausea, and fatigue.

Differentiating from other Diseases

Diseases with similar symptoms

Postgastrectomy complications:^[1]
- Postvagatomy diarrhea^[2]
- Small capacity syndrome^[3]
- Short bowel syndrome^[4]
- Afferent loop syndrome
- Efferent loop syndrome
Peptic ulcer disease
Fistula
Adhesion
Stenosis
Ischemia
Gastritis
Internal Hernia
Insulinoma
Glucose-lowering medication abuse
Symptomatic gallstone disease
Postprandial Hypotension^[5]
Irritable bowel syndrome (IBS)

Differential Diagnosis of Dumping Syndrome based on Postvagotomy complications symptoms:

The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are the following:^[6]^[7]^[3]


Differential Diagnosis for Postgastrectomy complications	Clinical features	Diagnosis

Short bowel syndrome	Upper abdominal pain, diarrhea, malnutrition, weight loss	LFTs, liver biopsy, Upper GI series, CT scan
Small-capacity syndrome	Early satiety, malnutrition, weight loss	Clinical diagnosis with a history of surgery
Afferent loop syndrome	Upper abdominal pain, early satiety, relief after vomiting	Ultrasound, Barium enema
Efferent loop syndrome	Upper abdominal pain, distention, vomiting	CT scan, Upper GI series
Postvagotomy diarrhea	Watery Diarrhea	Clinical diagnosis with a history of surgery

Differential Diagnosis of Dumping Syndrome based on Early Dumping Syndrome symptoms:

The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline They are as follows:


Differential Diagnosis for Early Dumping Syndrome symptoms	Clinical features	Diagnosis

Adhesions	Upper abdominal pain, vomiting, distention	CT scan, Upper GI series
Internal hernia	Upper abdominal pain, vomiting, early satiety	CT scan, Diagnostic laproscopy
Fistula	Upper abdominal pain, relief after vomiting, early satiety	Fistuloscopy, Endoscopy, Colonoscopy, Dye injection, CT scan
Ischemia	Upper abdominal pain, vomiting, diarrhea, distention	CT Angiography
Ulcer	Upper abdominal pain with food, nausea, acid reflux	Gastroscopy
Stenosis	Upper abdominal pain with food, nausea, acid reflux, dysphagia	Gastroscopy, Gastrografin swallow

Differential Diagnosis of Dumping Syndrome based on Late Dumping Syndrome symptoms:

The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are as follows:^[8]


Differential Diagnosis for Late Dumping Syndrome symptoms	Clinical features	Diagnosis

Insulinoma	Fasting hypoglycemia	After a 72 hour fast do labs: Glucose, C-peptide, Insulin, Proinsulin
Glucose-lowering medication abuse	Hypoglycemia	Sulfonylurea and C-peptide assay
Postprandial Hypotension	Nausea, lightheadedness,	Blood pressure checked before and after a meal

Differential diagnosis of abdominal pain

The differential diagnosis based on abdominal pain are as follows:

Classification of acute abdomen based on etiology		Presentation	Clinical findings								Diagnosis		Comments
Classification of acute abdomen based on etiology		Presentation	Fever	Rigors and Chills	Abdominal Pain	Jaundice	Hypotension	Guarding	Rebound Tenderness	Bowel sounds	Lab Findings	Imaging	Comments
Common causes of Peritonitis		Spontaneous bacterial peritonitis	+		Diffuse	−	−	−	−	Hypoactive	Ascitic fluid PMN>250 cells/mm³ Culture: Positive for single organism	Ultrasound for evaluation of liver cirrhosis	-
		Perforated gastric and duodenal ulcer	+		Diffuse	−	+	+	+	N	Ascitic fluid LDH > serum LDH Glucose < 50mg/dl Total protein > 1g/dl	Air under diaphragm in upright CXR	Upper GI endoscopy for diagnosis
		Acute suppurative cholangitis	+	+	RUQ	+	+	+	+	±
		Acute cholangitis	+	−	RUQ	+	−	−	−	N	Abnormal LFT	Ultrasound shows biliary dilatation	Biliary drainage (ERCP) + IV antibiotics
		Acute cholecystitis	+		RUQ	+		−	−	Hypoactive	Hyperbilirubinemia Leukocytosis	Ultrasound shows gallstone and evidence of inflammation	Murphy’s sign
		Acute pancreatitis	+		Epigastric	±		−	−	N	Increased amylase / lipase	Ultrasound shows evidence of inflammation	Pain radiation to back
		Acute appendicitis	+		RLQ	−		+	+	Hypoactive	Leukocytosis	Ultrasound shows evidence of inflammation	Nausea & vomiting, decreased appetite
		Acute diverticulitis	+		LLQ	±		+	−	Hypoactive	Leukocytosis	CT scan and ultrasound shows evidence of inflammation
Hollow Viscous Obstruction		Small intestine obstruction	−		Diffuse	−		+	±	Hyperactive then absent	Leukocytosis	Abdominal X ray	Nausea & vomiting associated with constipation, abdominal distention
		Gall stone disease/Cholelithiasis	±	−
		Volvulus	-		Diffuse	-		+	-	Hypoactive	Leukocytosis	CT scan and abdominal X ray	Nausea & vomiting associated with constipation, abdominal distention
		Biliary colic	-		RUQ	+		-	-	N	Increased bilirubin and alkaline phosphatase	Ultrasound	Nausea & vomiting
		Renal colic	-		Flank pain	-		-	-	N	Hematuria	CT scan and ultrasound	Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders	Ischemic causes	Mesenteric ischemia	±		Periumbilical	-		-	-	Hyperactive	Leukocytosis and lactic acidosis	CT scan	Nausea & vomiting, normal physical examination
	Ischemic causes	Acute ischemic colitis	±		Diffuse	-		+	+	Hyperactive then absent	Leukocytosis	CT scan	Nausea & vomiting
	Hemorrhagic causes	Ruptured abdominal aortic aneurysm	-		Diffuse	-		-	-	N	Normal	CT scan	Unstable hemodynamics
	Hemorrhagic causes	Intra-abdominal or retroperitoneal hemorrhage	-		Diffuse	-		-	-	N	Anemia	CT scan	History of trauma
Gynaecological Causes	Fallopian tube	Acute salpingitis	+		LLQ/ RLQ	−		±	±	N	Leukocytosis	Pelvic ultrasound	Vaginal discharge
	Ovarian cyst complications and endometrial disease	Torsion of the cyst	-		RLQ / LLQ	-		±	±	N	Increased ESR and CRP	Ultrasound	Sudden onset severe pain with nausea and vomiting
		Endometriosis	-		RLQ/LLQ	-		+/-	+/-	N	Normal	Laproscopy	Menstrual-associated symptoms, pelvic symptoms
		Cyst rupture	-		RLQ / LLQ	-		+/-	+/-	N	Increased ESR and CRP	Ultrasound	Sudden onset severe pain with nausea and vomiting
	Pregnancy	Ruptured ectopic pregnancy	-		RLQ / LLQ	-		-	-	N	Positive pregnancy test	Ultrasound	History of missed period and vaginal bleeding
Functional	Irritable Bowel Syndrome		-		Diffuse	-	-	-	-	N	Clinical diagnosis ROME III/IV criteria Pharmacologic studies based criteria	-	High dietary fiber Osmotic laxatives Antispasmodicdrugs

The following is a list of diseases that present with acute onset severe lower abdominal pain:


Disease	Findings
Ectopic pregnancy	History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.^[9]
Appendicitis	Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.^[10]
Ruptured ovarian cyst	Usually spontaneous, can follow history of trauma, mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.^[11]
Ovarian cyst torsion	Presents with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.^[12]
Hemorrhagic ovarian cyst	Presents with localized abdominal pain, nausea and vomiting. Hypovolemic shock may be present, abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.^[12]
Endometriosis	Presents with cyclic pain that is exacerbated by onset of menses, dyspareunia. laparoscopic exploration is diagnostic.^[12]
Acute cystitis	Presents with features of increased urinary frequency, urgency, dysuria, and suprapubic pain.^[13]^[14]

References

↑ "Postgastrectomy complications".
↑ "Explaining Diarrhea After Vagotomy". JAMA: The Journal of the American Medical Association. 195 (13): 37. 1966. doi:10.1001/jama.1966.03100130023009. ISSN 0098-7484.
↑ ^3.0 ^3.1 "Mastery of Surgery - Google Books".
↑ Farthing MJ (1993). "Octreotide in dumping and short bowel syndromes". Digestion. 54 Suppl 1: 47–52. PMID 8359568.
↑ van Beek, A. P.; Emous, M.; Laville, M.; Tack, J. (2017). "Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management". Obesity Reviews. 18 (1): 68–85. doi:10.1111/obr.12467. ISSN 1467-7881.
↑ "Short-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests".
↑ "The Dictionary of Modern Medicine - J.C. Segen - Google Books".
↑ Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, Kobayashi M, Hanazaki K (2013). "Diagnosis and management of insulinoma". World J. Gastroenterol. 19 (6): 829–37. doi:10.3748/wjg.v19.i6.829. PMC 3574879. PMID 23430217.
↑ Morin L, Cargill YM, Glanc P (2016). "Ultrasound Evaluation of First Trimester Complications of Pregnancy". J Obstet Gynaecol Can. 38 (10): 982–988. doi:10.1016/j.jogc.2016.06.001. PMID 27720100.
↑ Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994). "Acute appendicitis: CT and US correlation in 100 patients". Radiology. 190 (1): 31–5. doi:10.1148/radiology.190.1.8259423. PMID 8259423.
↑ Bottomley C, Bourne T (2009). "Diagnosis and management of ovarian cyst accidents". Best Pract Res Clin Obstet Gynaecol. 23 (5): 711–24. doi:10.1016/j.bpobgyn.2009.02.001. PMID 19299205.
↑ ^12.0 ^12.1 ^12.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.
↑ {{Cite journal | author = W. E. Stamm | title = Etiology and management of the acute urethral syndrome | journal = Sexually transmitted diseases | volume = 8 | issue = 3 | pages = 235–238 | year = 1981 | month = July-September | pmid = 7292216
↑ {{Cite journal | author = W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes | title = Causes of the acute urethral syndrome in women | journal = The New England journal of medicine | volume = 303 | issue = 8 | pages = 409–415 | year = 1980 | month = August | doi = 10.1056/NEJM198008213030801 | pmid = 6993946

Template:WH Template:WS

[urlPostgastrectomy_complications-1] "Postgastrectomy complications".

[2] "Explaining Diarrhea After Vagotomy". JAMA: The Journal of the American Medical Association. 195 (13): 37. 1966. doi:10.1001/jama.1966.03100130023009. ISSN 0098-7484.

[urlMastery_of_Surgery_-_Google_Books-3] 3.0 ^3.1 "Mastery of Surgery - Google Books".

[pmid8359568-4] Farthing MJ (1993). "Octreotide in dumping and short bowel syndromes". Digestion. 54 Suppl 1: 47–52. PMID 8359568.

[van_BeekEmous2017-5] van Beek, A. P.; Emous, M.; Laville, M.; Tack, J. (2017). "Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management". Obesity Reviews. 18 (1): 68–85. doi:10.1111/obr.12467. ISSN 1467-7881.

[urlShort-Bowel_Syndrome_Workup:_Laboratory_Studies,_Imaging_Studies,_Other_Tests-6] "Short-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests".

[urlThe_Dictionary_of_Modern_Medicine_-_J.C._Segen_-_Google_Books-7] "The Dictionary of Modern Medicine - J.C. Segen - Google Books".

[pmid23430217-8] Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, Kobayashi M, Hanazaki K (2013). "Diagnosis and management of insulinoma". World J. Gastroenterol. 19 (6): 829–37. doi:10.3748/wjg.v19.i6.829. PMC 3574879. PMID 23430217.

[pmid27720100-9] Morin L, Cargill YM, Glanc P (2016). "Ultrasound Evaluation of First Trimester Complications of Pregnancy". J Obstet Gynaecol Can. 38 (10): 982–988. doi:10.1016/j.jogc.2016.06.001. PMID 27720100.

[pmid8259423-10] Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994). "Acute appendicitis: CT and US correlation in 100 patients". Radiology. 190 (1): 31–5. doi:10.1148/radiology.190.1.8259423. PMID 8259423.

[pmid19299205-11] Bottomley C, Bourne T (2009). "Diagnosis and management of ovarian cyst accidents". Best Pract Res Clin Obstet Gynaecol. 23 (5): 711–24. doi:10.1016/j.bpobgyn.2009.02.001. PMID 19299205.

[pmid26760839-12] 12.0 ^12.1 ^12.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.

[13] {{Cite journal | author = W. E. Stamm | title = Etiology and management of the acute urethral syndrome | journal = Sexually transmitted diseases | volume = 8 | issue = 3 | pages = 235–238 | year = 1981 | month = July-September | pmid = 7292216

[14] {{Cite journal | author = W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes | title = Causes of the acute urethral syndrome in women | journal = The New England journal of medicine | volume = 303 | issue = 8 | pages = 409–415 | year = 1980 | month = August | doi = 10.1056/NEJM198008213030801 | pmid = 6993946

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@@ Line 4: / Line 4: @@
 ==Overview==
-Dumping syndrome may often be confused with other similar diseases that cause upper abdominal pain, nausea, and fatigue.
+[[Gastric dumping syndrome|Dumping syndrome]] may often be confused with other similar diseases that cause upper [[abdominal pain]], [[Nausea and vomiting|nausea]], and [[fatigue]].
 ==Differentiating from other Diseases==
 ===Diseases with similar symptoms===
 * Postgastrectomy complications:<ref name="urlPostgastrectomy complications">{{cite web |url=https://www.uptodate.com/contents/postgastrectomy-complications?source=search_result&search=dumping%20syndrome&selectedTitle=2~58#H8245424 |title=Postgastrectomy complications |format= |work= |accessdate=}}</ref>
-** Postvagatomy diarrhea<ref>{{cite journal|title=Explaining Diarrhea After Vagotomy|journal=JAMA: The Journal of the American Medical Association|volume=195|issue=13|year=1966|pages=37|issn=0098-7484|doi=10.1001/jama.1966.03100130023009}}</ref>
+** Postvagatomy [[diarrhea]]<ref>{{cite journal|title=Explaining Diarrhea After Vagotomy|journal=JAMA: The Journal of the American Medical Association|volume=195|issue=13|year=1966|pages=37|issn=0098-7484|doi=10.1001/jama.1966.03100130023009}}</ref>
 ** Small capacity syndrome<ref name="urlMastery of Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=PgUFJg_-f4YC&pg=PA952&lpg=PA952&dq=small+capacity+syndrome&source=bl&ots=f0TebFuKK1&sig=CVIB44xCURFPi0CctG9-MWCsMnU&hl=en&sa=X&ved=0ahUKEwiU7IC0l-LXAhUB2oMKHQ4HBEEQ6AEIMjAC#v=onepage&q=small%20capacity%20syndrome&f=false |title=Mastery of Surgery - Google Books |format= |work= |accessdate=}}</ref>
-** Short bowel syndrome<ref name="pmid8359568">{{cite journal |vauthors=Farthing MJ |title=Octreotide in dumping and short bowel syndromes |journal=Digestion |volume=54 Suppl 1 |issue= |pages=47–52 |year=1993 |pmid=8359568 |doi= |url=}}</ref>
+** [[Short bowel syndrome]]<ref name="pmid8359568">{{cite journal |vauthors=Farthing MJ |title=Octreotide in dumping and short bowel syndromes |journal=Digestion |volume=54 Suppl 1 |issue= |pages=47–52 |year=1993 |pmid=8359568 |doi= |url=}}</ref>
-** Afferent loop syndrome
+** [[Afferent loop syndrome]]
 ** Efferent loop syndrome
-* Peptic ulcer disease
+* [[Peptic ulcer|Peptic ulcer disease]]
-* Fistula
+* [[Fistula]]
-* Adhesion
+* [[Adhesion]]
-* Stenosis
+* [[Stenosis]]
-* Ischemia
+* [[Ischemia]]
-* Gastritis
+* [[Gastritis]]
-* Internal Hernia
+* Internal [[Hernia]]
-* Insulinoma
+* [[Insulinoma]]
-* Glucose-lowering medication abuse
+* [[Glucose]]-lowering medication abuse
 * Symptomatic gallstone disease
-* Postprandial Hypotension<ref name="van BeekEmous2017">{{cite journal|last1=van Beek|first1=A. P.|last2=Emous|first2=M.|last3=Laville|first3=M.|last4=Tack|first4=J.|title=Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management|journal=Obesity Reviews|volume=18|issue=1|year=2017|pages=68–85|issn=14677881|doi=10.1111/obr.12467}}</ref>
+* [[Postprandial]] [[Hypotension]]<ref name="van BeekEmous2017">{{cite journal|last1=van Beek|first1=A. P.|last2=Emous|first2=M.|last3=Laville|first3=M.|last4=Tack|first4=J.|title=Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management|journal=Obesity Reviews|volume=18|issue=1|year=2017|pages=68–85|issn=14677881|doi=10.1111/obr.12467}}</ref>
-*Short bowel syndrome
+*[[Irritable bowel syndrome]] (IBS)
-*Irritable bowel syndrome (IBS)
 ===Differential Diagnosis of Dumping Syndrome based on Postvagotomy complications symptoms:===
-The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are the following:<ref name="urlShort-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests">{{cite web |url=https://emedicine.medscape.com/article/193391-workup#c8 |title=Short-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests |format= |work= |accessdate=}}</ref><ref name="urlThe Dictionary of Modern Medicine - J.C. Segen - Google Books">{{cite web |url=https://books.google.com/books?id=FbSlyyshjOoC&pg=PA183&lpg=PA183&dq=small+capacity+syndrome+dumping+-gut&source=bl&ots=jxTdlNDcwC&sig=opIV9WoEa6yCIY6udkil_Mq3rYE&hl=en&sa=X&ved=0ahUKEwjrz72gn-LXAhUK7YMKHTOXCZMQ6AEIYjAN#v=onepage&q=small%20capacity%20syndrome%20dumping%20-gut&f=false |title=The Dictionary of Modern Medicine - J.C. Segen - Google Books |format= |work= |accessdate=}}</ref><ref name="urlMastery of Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=PgUFJg_-f4YC&pg=PA952&lpg=PA952&dq=small+capacity+syndrome&source=bl&ots=f0TebFuKK1&sig=CVIB44xCURFPi0CctG9-MWCsMnU&hl=en&sa=X&ved=0ahUKEwiU7IC0l-LXAhUB2oMKHQ4HBEEQ6AEIMjAC#v=onepage&q=small%20capacity%20syndrome&f=false |title=Mastery of Surgery - Google Books |format= |work= |accessdate=}}</ref>
+The differential diagnosis of [[Gastric dumping syndrome|dumping syndrome]] is based on the early [[Gastric dumping syndrome|dumping syndrome]] timeline.They are the following:<ref name="urlShort-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests">{{cite web |url=https://emedicine.medscape.com/article/193391-workup#c8 |title=Short-Bowel Syndrome Workup: Laboratory Studies, Imaging Studies, Other Tests |format= |work= |accessdate=}}</ref><ref name="urlThe Dictionary of Modern Medicine - J.C. Segen - Google Books">{{cite web |url=https://books.google.com/books?id=FbSlyyshjOoC&pg=PA183&lpg=PA183&dq=small+capacity+syndrome+dumping+-gut&source=bl&ots=jxTdlNDcwC&sig=opIV9WoEa6yCIY6udkil_Mq3rYE&hl=en&sa=X&ved=0ahUKEwjrz72gn-LXAhUK7YMKHTOXCZMQ6AEIYjAN#v=onepage&q=small%20capacity%20syndrome%20dumping%20-gut&f=false |title=The Dictionary of Modern Medicine - J.C. Segen - Google Books |format= |work= |accessdate=}}</ref><ref name="urlMastery of Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=PgUFJg_-f4YC&pg=PA952&lpg=PA952&dq=small+capacity+syndrome&source=bl&ots=f0TebFuKK1&sig=CVIB44xCURFPi0CctG9-MWCsMnU&hl=en&sa=X&ved=0ahUKEwiU7IC0l-LXAhUB2oMKHQ4HBEEQ6AEIMjAC#v=onepage&q=small%20capacity%20syndrome&f=false |title=Mastery of Surgery - Google Books |format= |work= |accessdate=}}</ref>
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
 | valign="top" |
@@ Line 71: / Line 70: @@
 ===Differential Diagnosis of Dumping Syndrome based on Early Dumping Syndrome symptoms:===
-The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline They are as follows:
+The differential diagnosis of [[Gastric dumping syndrome|dumping syndrome]] is based on the early [[Gastric dumping syndrome|dumping syndrome]] timeline They are as follows:
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
 | valign="top" |
@@ Line 119: / Line 118: @@
 === '''Differential Diagnosis of Dumping Syndrome based on Late Dumping Syndrome symptoms:''' ===
-The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are as follows:<ref name="pmid23430217">{{cite journal |vauthors=Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, Kobayashi M, Hanazaki K |title=Diagnosis and management of insulinoma |journal=World J. Gastroenterol. |volume=19 |issue=6 |pages=829–37 |year=2013 |pmid=23430217 |pmc=3574879 |doi=10.3748/wjg.v19.i6.829 |url=}}</ref>
+The differential diagnosis of [[Gastric dumping syndrome|dumping syndrome]] is based on the early [[Gastric dumping syndrome|dumping syndrome]] timeline.They are as follows:<ref name="pmid23430217">{{cite journal |vauthors=Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y, Kobayashi M, Hanazaki K |title=Diagnosis and management of insulinoma |journal=World J. Gastroenterol. |volume=19 |issue=6 |pages=829–37 |year=2013 |pmid=23430217 |pmc=3574879 |doi=10.3748/wjg.v19.i6.829 |url=}}</ref>
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
@@ Line 130: / Line 129: @@
 ! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Diagnosis}}
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Insulinoma
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Insulinoma]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Fasting hypoglycemia
+* Fasting [[hypoglycemia]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* After a 72 hour fast do labs: Glucose, C-peptide, Insulin, Proinsulin
+* After a 72 hour fast do labs: [[Glucose]], [[C-peptide]], [[Insulin]], [[Proinsulin]]
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Glucose-lowering medication abuse
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Glucose]]-lowering medication abuse
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Hypoglycemia
+* [[Hypoglycemia]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*
+* [[Sulfonylurea]] and [[C-peptide]] [[assay]]
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Postprandial Hypotension
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Postprandial]] [[Hypotension]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Nausea, lightheadedness,
+* [[Nausea and vomiting|Nausea]], [[Lightheadedness and vertigo (patient information)|lightheadedness]],
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Blood pressure checked before and after meal
+* [[Blood pressure]] checked before and after a meal
 |}
 ==Differential diagnosis of abdominal pain==
-The differential diagnosis based on abdominal pain are as follows:
+The differential diagnosis based on [[abdominal pain]] are as follows:
 {| align="center"
 |-