Gastric Outlet Obstruction

Question 1

Benign Causes gastric outlet obstruction? (8)

Answer 1

• pud 5%
• gastric polyps
• caustic ingestion
• pyloric stenosis (congenital)
• congenital duodenal webs
• bouveret syndrome: gallstone obstruction
• pancreatic pseudocysts
• bezoars

Question 2

Malignant Causes gastric outlet obstruction? (6)

Answer 2

• Pancreatic cancer most common
• ampullary cancer
• duodenal
• cholangiocarcinoma
• gastric
• metastasis

Question 3

Symptoms gastric outlet obstruction?

Answer 3

• Forceful! Vomiting of undigested food
• symptoms of underlying cause eg pud: gastric retention, early satiety, bloating or epigastic fullness, indigestion, anorexia, epigastric pain, weight loss, dehydration etc

Question 4

Physical Examination findings of gastric outlet obstruction? (2)

Answer 4

• chronic dehydration, Malnutrition
• tympanitic mass (dilated stomach) epigastric area or left upper quadrant

Question 5

Investigations for gastric outlet obstruction? (3)

Answer 5

• Bloods: dehydration (increased blood urea nitrogen bun and creatinine ), hypokalemic hypochloremic metabolic alkalosis due to vomiting, test for h pylori
• AXR: gastric dilatation
• endoscopy: visualise anatomy, sodium chloride load test