Gastric outlet obstruction

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Gastric outlet obstruction
Classification and external resources
GOO AXR.jpg
Decubitus x-ray of abdomen of patient with gastric outlet obstruction. There is a prominent gastric air bubble, gastric air-fluid level, and a dilated stomach with particulate matter within it.
ICD-10 K31.1
ICD-9 537.0
eMedicine article/190621

Gastric outlet obstruction (often abbreviated as GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with gastric outlet obstruction will often have recurrent vomiting of food that has accumulated in the stomach, but which cannot pass into the small intestine due to the obstruction. The stomach often dilates to accommodate food intake and secretions. Causes of gastric outlet obstruction include both benign causes (such as peptic ulcer disease affecting the area around the pylorus), as well as malignant causes, such as gastric cancer.

Causation related to ulcers may involve severe pain which the patient may interpret as a heart condition/attack.[1]

Treatment of the condition depends upon the underlying cause; it can involve antibiotic treatment when H. Pylori is related to an ulcer,[2] endoscopic therapies (such as dilation of the obstruction with balloons or the placement of self expandable metallic stents), other medical therapies, or surgery to resolve the obstruction.

Causes[edit]

The causes are divided into benign or malignant.

Pathophysiology[edit]

In a peptic ulcer it is believed to be a result of edema and scarring of the ulcer, followed by healing and fibrosis, which leads to obstruction of the gastroduodenal junction (usually an ulcer in the first part of the duodenum).[3]

Clinical features[edit]

The main symptom is vomiting, which typically occurs after meals of undigested food, devoid of any bile. A history of previous peptic ulcers and loss of weight is not uncommon. In advanced cases, signs to look for on upon physical examination are wasting and dehydration. Visible Peristalsis may be present. Succussion splash is a splash-like sound heard over the stomach in the left upper quadrant of the abdomen on shaking the patient, with or without the stethoscope.

Management[edit]

Investigations[edit]

The most confirmatory investigation is endoscopy of upper gastrointestinal tract.

Laboratory

Abdominal X-ray

  • A gastric fluid level may be seen which would support the diagnosis.

Barium meal and follow through

  • May show an enlarged stomach and pyloroduodenal stenosis.[4]

Gastroscopy

  • May help with cause and can be used therapeutically.

Treatment[edit]

Treatment of gastric outlet obstruction depends on the cause, but is usually either surgical or medical.

Medical In most patients with peptic ulcer disease, the oedema will usually settle with conservative management with nasogastric suction, replacement of fluids and electrolytes and proton pump inhibitors.

Surgical Surgery is indicated in cases of gastric outlet obstruction in which there is significant obstruction and in cases where medical therapy has failed.[citation needed] Endoscopic balloon therapy may be attempted as an alternative to surgery, with balloon dilation reporting success rates of 76% after repeat dilatons.[5] The operation usually performed is an antrectomy, the removal of the antral portion of the stomach. Other surgical approaches include: vagotomy, the severing of the vagus nerve, the Billroth I, a procedure which involves anastomosing the duodenum to the distal stomach, or a gastrojejunostomy.

Differential Diagnosis[edit]

The differential diagnosis of gastric outlet obstruction may include: hiatal hernia, gastroesophageal reflux, adrenal insufficiency, and inborn errors of metabolism.[citation needed]

References[edit]

  1. ^ http://www.webmd.com/digestive-disorders/digestive-diseases-peptic-ulcer-disease
  2. ^ http://www.webmd.com/digestive-disorders/digestive-diseases-peptic-ulcer-disease
  3. ^ Doherty GM, Way LW, editors. Current Surgical Diagnosis & Treatment. 12th Edition. New York: Mcgraw-Hill; 2006.
  4. ^ Mieny CJ. General Surgery.6th Ed. Pretoria: Van Schaik; 2006.
  5. ^ Lam YH, Lau JY, Fung TM, et al. Endoscopic balloon dilation for benign gastric outlet obstruction with or without Helicobacter pylori infection. Gastrointest Endosc. Aug 2004;60(2):229-33

Gastric outlet obstruction due to duodenal tuberculosis