GASTROPARESIS AND GASTRIC OUTLET OBSTRUCTION

Question 1

What is gastroparesis?

Answer 1

Reduced mobility of the stomach, resulting in food remaining in the stomach for an abnormally long time. Normally the result of vagal never damage.

Question 2

What are the causes of gastroparesis?

Answer 2

Previous surgival vagotomy
Autonomic neuropathy - often from diabetes
Idiopathic
Connective tissue disease - Ehlers-Danlos, scleroderma
Parkinson’s
Hypochlorydria

Question 3

What are the clinical features of gatroparesis?

Answer 3

Chronic nausea (especially morning nausea)
Vomiting
Abdominal pain
Feeling of fullness after a few bites
Weight loss and malnutrition
Heartburn

Question 4

Who is more affected by gastroparesis?

Answer 4

Women

Question 5

What investigations would you for someone with the signs and symptoms of gastroparesis and what might you see?

Answer 5

Barium meal - distension of stomach with reduced passage of barium in duodenum
Radioisotope scan

Question 6

What are the treatment options for someone diagnosed with gastroparesis?

Answer 6

Antiemetics with prokinetic action - Domperidone or metoclopramide
In severe cases a motilin analogue such as erythromycin might be needed.
Gastric pacemaker can be used in patients with refractory symptoms

Question 7

What causes gastric outlet obstruction?

Answer 7

Long standing peptic ulcer disease leading to scarring and narrowing of the gastric outlet.
Can be as a result of compression on outlet by gastric or pancreatic cancer, or by lymph nodes.

Question 8

What do we call gastric outlet obstruction affecting the pylorus?

Answer 8

Pyloric stenosis (not to be confused with congenital type which is not due to scarring but hypertrophy of fibromuscular layer)

Question 9

What are the clinical features of gastric outlet obstruction?

Answer 9

Vomiting - often projectile

Sloshing sound heard in epigastric regions

Question 10

What investigations would be ordered for someone with suspected gastric outlet obstruction?

Answer 10

Barium meal
Endoscopy
U&Es

Question 11

Why would you do U&Es in someone with gastric outlet obstruction?

Answer 11

Check for metabolic alkalosis and hypokalaemia due to prolonged vomiting

Question 12

What are the complications of gastric outlet obstruction?

Answer 12

Metabolic alkalosis
Aspiration pneumonia
Malnutrition

Question 13

How do you manage someone with gastric out obstruction?

Answer 13

Correct dehydration, electrolyte imbalances and metabolic alkalosis with IV fluids
NG tube to aspirate gastric contents - prevent further vomiting
Surgical intervention - required unless obstruction is due to oedema
Endoscopy guided balloon dilatation
Placement of stent for malignant strictures