Nausea and vomiting

Question 1

Which conditions are associated with gastric outlet obstruction syndrome

Answer 1

Peptic ulcer disease (it can cause scarring and pyloric stenosis)

Impaction of gallstone in the pylorus (a very proximal form of gallstone ileus. The gallstone can only get into GI tract via a cholcysto-enteric fistula)

Others too

Question 2

Relief after vomiting?

Answer 2

Consistent with obstruction

Question 3

Early morning vomiting?

Answer 3

Pregnancy and raised ICP

Question 4

Medications causing nausea and vomiting?

Answer 4

Opiates, chemotherapy, anticonvulsants, antibiotics, etc. can
all cause nausea and vomiting

Question 5

What does vomiting within an hour of eating suggest?

What about if it’s longer after eating

Answer 5

− Vomiting within an hour of eating suggests an obstruction high in the gastrointestinal (GI) tract proximal to the gastric outlet. If this is the case, you
should ask about peptic ulcer disease as this can cause scarring and pyloric
stenosis.

− Vomiting after a longer post-prandial delay is consistent with an obstruction lower in the GI tract, usually in the small bowel.

Question 6

What symptoms together suggest gastroparesis/gastric outlet obstruction

Answer 6

early satiety,
post prandial bloating,
abdominal discomfort