Gastric Outlet Obstruction Flashcards
What is GASTRIC OUTLET OBSTRUCTION (BOO)
*It describes the clinical manifestation of impaired gastric emptying commonly caused by chronic peptic ulcer, gastric ulcer, pyloric/duodenal stenosis.
Diagnosis of gastric outlet obstruction
*clinical- Non bilious vomiting, risk factors of PUD
*Physical examination - patient loses weight, appears unwell and distended abdomen.
What is succussion splash
*patient should not eat - for 2hrs before examination.
* Put 2 hands on both ASIS and shake the patient and put your head on the patient abdomen to listen for sounds.
Laboratory findings in gastric outlet obstruction
*hyponatremia,
*hypokalemia
*hypochloremia,
*metabolic alkalosis
, *uacid urea (found in PUD).
Management of gastric obstruction outlet
*Set IV line- take blood for sample (FBC, PCV) NS rehydration
*Pass urethral catheter to monitor input and output hriv
*Empty stomach by using wide-bore gastric tube or gastric lavage with normal saline
* Perform endoscopy, contrast serology, biopsy Give patient anti-secretory agent (omeprazole)
Give Antibiotics, analgesics
Surgical: fi cancer perform Bilroth I or II
If benign- draining procedure- gastroenterotomy.
What is INTESTINAL OBSTRUCTION
*Is the stoppage in the onward flow of intestinal contents. It occurs distal to the ampulla of vater, hence ti is characterized by Bilious vomiting.
Classification of intestinal obstruction
1 *Dynamic or Mechanical IO: this occurs when something within the lumen, wall or outside of the gut stop or restrict the movement of intestinal content. It intraluminal, causes. intramural and extramural
2: Adynamic or Functional IO: here there is paralysis of intestinalwall musculature leading to inability to propel the intestinal contents as in paralytic ileus, occurring post- laparotomy. E.g. post. Abdominal surgery, Peritonitis, spinal injury, hypokalemia, mesenteric artery thrombosi
Classification according to the onset
Mechanical IO is subdivided as:
Acute - of sudden onset
Chronic- of slow progression
Acute on chronic- previously chronic case
becoming acute.
Acute Mechanical I0 is further sub-classified based on site and nature of obstruction.
Based on site ofObstruction
*High I 0 : this affects the lower duodenum,
jejunum and upper ileum.
*Lower I0: this affects the terminal ileum and colon.
Based on nature of Obstruction
*S i m p l e : isolated occlusion of bowel
lumen with no impairment of blood supply.
*Strangulated: occlusion of bowel lumen with impairment of blood supply.
*Closed Loop: obstructed loop is closed at both ends so that nothing can escape from it proximally or distally e.g. hernia or volvulus.
Causes of intestinal obstruction
1*Hernia, adhesions, laparoscopic surgeries, foreign body,
gallstones, paralytic ileus, volvulus, crohn’s disease, colorectal cancer, hirschsprung’s diseases Intussusception, s
strictures (Hx of TB or
prolonged diarrhea diseases)
Causes of intestinal obstruction 2
CHARGE and VACTERLH
CHARGE AND VACTERL-H
C- Coloboma of eye
H- Heart abnormalities
A- Anorectal malformation
R- Renal anomaly
G- Genital anomaly
E- Ear problems of congenital
V- Vertebral anomaly
A- Anorectal malformation
C- Cardiac anomaly
TE- Traceo-oesophageal anomaly
R- Renal anomaly
L- Limb problems
H- Hydrocephalus
Clinical features of intestinal obstruction
Vomiting,
constipation,
abdominal
pain (colicky),
a b d o m i n a l
distension,
fever, weakness, headache, dyspnea, decrease urine volume,
altered
sensorium,
associated abdominal mass, failure to thrive.
Investigations of intestinal obstruction
*FBC, Urinalysis, urine mcs, serum E/U/Cr, chest X-ray, plain abdominal x-ray, contrast study (using gastrograffin) Volvulus shows Bird beak deformity,
X ray findings of intestinal obstruction
- Supine view shows: gaseous dilated bowel loop
*Small intestine: dilated bowel is central, valvulaeconniventes seen.
*Colon: dilated bowel is in the flank, haustration seen Erect view shows: multiple air- fluid level, absent gas shadow in the pelvis - Three (3) physiology air-fluid level- Gastric, Duodenal C-loop, Ileocaecal junction
