Gastric outlet obstruction

Source: Wikipedia, the free encyclopedia.
Gastric outlet obstruction
on their side. There is a prominent gastric air bubble, gastric air-fluid level, and a dilated stomach with particulate matter within it.
SpecialtyGeneral surgery, gastroenterology

Gastric outlet obstruction (GOO) is a medical condition where there is an obstruction at the level of the

gastric cancer
.

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

Treatment of the condition depends upon the underlying cause; it can involve antibiotic treatment when Helicobacter pylori is related to an ulcer,[1] 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.

Signs and symptoms

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 physical examination are

borborygmi) due to excessive peristaltic action of the stomach. Fullness in the left hypochondrium
may also be present.

Causes

The causes are divided into benign or malignant.

  • Benign
  • Malignant
    • Tumours of the stomach, including
      gastrointestinal stromal tumours

Pathophysiology

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).[2]

Diagnosis

The most confirmatory investigation is endoscopy of upper gastrointestinal tract.

Laboratory often find hypochloremic, hypokalemic, and alkalotic due to loss of hydrogen chloride and potassium. High urea and creatinine levels may also be observed if the patient is dehydrated.

Abdominal X-ray may show a gastric fluid level which would support the diagnosis.

Barium meal and follow through may show an enlarged stomach and pyloroduodenal stenosis.[3]

Gastroscopy may help with cause and can be used therapeutically.

Differential diagnosis

The differential diagnosis of gastric outlet obstruction may include: early gastric carcinoma,

gastroesophageal reflux, adrenal insufficiency, and inborn errors of metabolism.[citation needed
]

Treatment

Treatment of gastric outlet obstruction depends on the cause, but is usually either

medical.[citation needed
]

Medication

In most people with peptic ulcer disease, the oedema will usually settle with conservative management with nasogastric suction, replacement of fluids and electrolytes and

proton pump inhibitors.[citation needed
]

Surgery

Surgery is indicated in cases of gastric outlet obstruction in which there is significant obstruction and in cases where medical therapy has failed.[

anastomosing the duodenum to the distal stomach, or a bilateral truncal vagotomy with gastrojejunostomy
.

References

  1. ^ a b "Peptic Ulcer: Causes, Symptoms, and Treatment".
  2. ^ Doherty GM, Way LW, editors. Current Surgical Diagnosis & Treatment. 12th Edition. New York: Mcgraw-Hill; 2006.
  3. ^ Mieny CJ. General Surgery.6th Ed. Pretoria: Van Schaik; 2006.
  4. ^ 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

External links

Gastric outlet obstruction due to duodenal tuberculosis

Retrieved from "https://en.wikipedia.org/w/index.php?title=Gastric_outlet_obstruction&oldid=1205174187"