Gastric outlet obstruction
| Gastric outlet obstruction | |
|---|---|
| Classification and external resources | |
 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. |
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| 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. Treatment of the condition depends upon the underlying cause; it can involve 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.
Contents |
[edit] Symptoms
Projectile vomiting, which may also occur with an Epidural Hematoma or meningitis, constipation, loss of weight,sometimes epigastric pain.
[edit] Causes
The causes are divided into benign or malignant. Projectile vomiting may also occur with an Epidural Hematoma.
[edit] Benign
Peptic ulcer disease.
Infections, such as tuberculosis; and infiltrative diseases, such as amyloidosis.
A rare cause of gastric outlet obstruction is obstruction with a gallstone, also termed Bouveret's syndrome.
[edit] Malignant
Tumours of the stomach, including adenocarcinoma (and its linitis plastica variant), lymphoma, and gastrointestinal stromal tumours;
[edit] Pathophysiology
In a peptic ulcer it is believed to be a result of oedema and scarring of ulcer, followed by healing and fibrosis, which leads to obstruction of the gastroduodenal junction (usually an ulcer in the first part of the duodenum).[1] In a malignancy usually a malignancy of the antrum of the stomach or the pancreas.
[edit] Clinical Features
The main symptom is that of vomiting which typically occurs after meals of undigested food, devoid of any bile. You may also find a history of previous peptic ulcers and loss of weight.
Signs to look for upon examination are wasting and dehydration. visible Peristalsis may be present.Succussion splash which 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. Laboratory features to look for include hypochloremic hypokalemic Metabolic alkalosis (due loss of HCL), and an electrolyte imbalance.
Investigations
the most confirmatory investigation is endoscopy of upper GIT.
Abdominal X-ray - Gastric fluid level. Ba meal and follow through - enlarged stomach and pyloroduodenal stenosis.[2] Gastroscopy - Help with cause and therapeutic.
Treatment of gastric outlet obstruction depends on the cause, but may include either surgery or medical. In 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.
Indicated in cases of failed medical therapy and recurrent obstruction. The surgery usually performed is an Antrectomy(which is the partial removal of the stomach), Vagotomy (which is severing of the vagus nerve) and Billroth I (which involves anastomosing the duodenum to the distal stomach) or gastrojejunostomy. This helps reduce acid in the stomach which is responsible for the peptic ulcer.
