[13] Gastric Outlet Obstruction Flashcards
What can cause gastric outlet obstruction?
Fibrotic stricturing
Gastric cancer
What can cause fibrotic stricturing leading to gastric outlet obstruction?
Late complication of PUD
What features of the history might be present in gastric outlet obstruction?
History of bloating, early satiety, and nausea
How does gastric outlet obstruction present?
Copious projectile, non-bilious vomiting a few hours after meals
What might the vomit contain in gastric outlet obstruction?
Stale food
What may be found on examination in gastric outlet obstruction?
Epigastric distention
Succession splash
How is gastric outlet obstruction investigated?
ABG
AXR
OGD
Contrast meal
What is found on ABG in gastric outlet obstruction?
Hypochloraemic hypokalaemia metabolic alkalosis
What is found on AXR in gastric outlet obstruction?
Dilated gastric air bubble
Collapsed distal bowel
How is metabolic abnormality corrected in gastric outlet obstruction?
0.9% normal saline and KCl
How is benign gastric outlet obstruction managed?
Endoscopic balloon dilatation
Pyloroplasty or gastroenterostomy
How is malignant gastric outlet obstruction managed?
Stenting
Resection
What is the male to female ratio of hypertrophic pyloric stenosis?
M:F = 4:1
Which race has a higher incidence of hypertrophic pyloric stenosis?
Caucasians
When does hypertrophic pyloric stenosis present?
6-8 weeks old
How does hypertrophic pyloric stenosis present?
Projectile vomiting minutes after feeding
What is found on examination in hypertrophic pyloric stenosis?
RUQ mass size of olive
Visible peristalsis
How is hypertrophic pyloric stenosis diagnosed?
Test feed to palpate mass and see peristalsis
Ultrasound
What is found on ABG in hypertrophic pyloric stenosis?
Hypochloraemic hyperkalaemia metabolic acidosis
How is hypertrophic pyloric stenosis managed?
Resuscitate and correct metabolic abnormality
NGT
Ramstedt pyloromyotomy
What happens in a Ramstedt pyloromyotomy?
The muscularis propria is divided