Stomach: Gastric outlet obstruction Flashcards
(16 cards)
What is the definition of gastric outlet obstruction?
Mechanical obstruction of stomach or duodenum
What is the most common cause of obstruction from malignancy?
Cancer must be ruled out as obstruction from peptic ulcer disease is now less common
List benign causes of gastric outlet obstruction.
- Inflammatory
- Peptic Ulcer disease (acute vs chronic)
- IBD (Crohn’s)
- Pancreatitis
- Infectious (TB)
- Traumatic
- Caustic injury
- Foreign Body
- Gallstone
- Food impaction
- Iatrogenic (post-surgical stenosis, PEG tube or stent migration)
What are malignant causes of gastric outlet obstruction?
- Extrinsic (pancreatic cancer, carcinomatosis)
- Intrinsic (gastric cancer, duodenal cancer)
What are the common presentations of gastric outlet obstruction?
- Epigastric pain
- Nausea and vomiting
- Abdominal distension
- Early satiety
- Weight loss (if long duration)
What findings are typically observed during the examination of gastric outlet obstruction?
Usually normal; may find mass or distension, signs of advanced malignance
What blood investigation finding is associated with gastric outlet obstruction?
Metabolic Alkalosis
What causes hypokalaemic, hypochloraemic metabolic alkalosis in gastric outlet obstruction?
Loss of K, Cl and H in vomit; kidney excretes HCO3 to maintain pH
What imaging is often performed to look for underlying lesions in gastric outlet obstruction?
CT scan
What is the most useful assessment tool for diagnosis and initial therapy if malignancy is not suspected?
Endoscopy
What initial management steps should be taken for gastric outlet obstruction?
- NBM
- IV fluids
- NGT for gastric decompression
- Anti-emetics
- PPIs (reduce gastric secretions)
What nutritional support may be required in cases of gastric outlet obstruction?
Depends on site of obstruction and underlying cause; may need form of feeding distal to occlusion
What is the management approach for malignant gastric outlet obstruction?
- Staging
- MDT discussion
- Oncological management if resected
What treatments are appropriate for benign causes of gastric outlet obstruction?
- Treatment of PUD
- Treatment of IBD
- Treatment of TB
- Endoscopic management (dilation or stenting)
What surgical procedure may be performed for refractory gastric outlet obstruction?
Antrectomy and reconstruction (Billroth II)
Fill in the blank: Obstruction from _______ disease is now less common than obstruction from malignancy.
peptic ulcer
