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Gastric Outlet Obstruction


Presentation

  • However, in the present case, no clinical features of immunodeficiency were observed and HIV status being negative. The present case presented with gastric outlet obstruction which clinically and endoscopically mimicked gastric carcinoma.[jmedscindmc.com]
  • CT Abdomen Pelvis upon presentation. (a) Marked distention of the stomach with fluid. (b) Pneumobilia involving left lobe of liver. (Arrow pointing). Figure 1. CT Abdomen Pelvis upon presentation. (a) Marked distention of the stomach with fluid.[tandfonline.com]
  • Patients with an underlying malignancy can clinically present in a variety of ways.[cancertherapyadvisor.com]
  • Gastric outlet obstruction is the most common presentation in most cases.[encyclopedia2.thefreedictionary.com]
  • On review of literature vomiting was the most common presentation followed by GI bleeding., [3], [9] In our series vomiting and weight loss were the constant finding and none of our patients presented with GI bleed.[afrjpaedsurg.org]
Anemia
  • […] improvement in luminal diameter post-operatively, development of adhesions, ease in surgery, healing at the operation site and least post operative complications (Matthiesen et al. 2 The clinical presentation can vary widely, including asymptomatic anemia[encyclopedia2.thefreedictionary.com]
  • Laboratory investigation revealed anemia (hemoglobin – 7.6 g/dL). Abdomen radiograph showed marked gastric distension with gastric camera barely visible ( Fig. 1 ).[elsevier.es]
  • Blind Loop syndrome Bacterial overgrowth in static loop causing bind with B12 and deconjugate bile acid which results in deficiency of Vitamin B12 and Megaloblastic anemia.[slideshare.net]
  • Laboratory testing showed normocytic normochromic anemia with hemoglobin 10.5   10 g/L (10.5 g/dL), leukocytosis with white cell count 11.2   10 9 /L (95.2% neutrophils), renal impairment with creatinine 176.79 μmol/L (2.0 mg/dL) and blood urea nitrogen[bmcresnotes.biomedcentral.com]
  • Anemia and abnormal liver function tests may reflect the underrlying disease. Elevated serum gastrin levels due to distention-induced gastrin release (400 to 800 pg/ mL range) can occur and can lead to confusion with Zollinger- Ellison syndrome.[tropicalgastro.com]
Amyloidosis
  • Benign Peptic ulcer disease Infections, such as tuberculosis; and infiltrative diseases, such as amyloidosis. A rare cause of gastric outlet obstruction is blockage with a gallstone, also termed Bouveret's syndrome.[tipstovoid.blogspot.com]
  • Benign Peptic ulcer disease Infections, such as tuberculosis ; and infiltrative diseases, such as amyloidosis. A rare cause of gastric outlet obstruction is blockage with a gallstone, also termed "Bouveret syndrome" or "Bouveret's syndrome".[en.wikipedia.org]
  • Rare causesRare causes Gastric bezoars Large gastric polyps Gastric vovlulus Bouveret’s syndrome Amyloidosis 12.[slideshare.net]
  • Common causes of GOO include peptic ulcer disease (PUD), gastric polyps, caustic ingestion, duodenal stricture, systemic amyloidosis of the gastrointestinal tract, eosinophillic gastroenteritis and obstruction by gallstones.[wikidoc.org]
Wound Infection
  • ., 2012 64 F End colostomy Refuse operative repair None No Discharge Marsh and Hoejgaard, 2013 81 M End colostomy Laparotomy Stoma transposition No Wound infection Barber-Millet et al., 2014 69 F End colostomy Laparotomy Stoma transposition Preventive[academic.oup.com]
  • Open gastrojejunostomy patients were found to have more “major” complications, including respiratory tract infections, myocardial infarction, acute renal failure, and wound infection, but better long-term patency.[healio.com]
Poor Feeding
  • The characteristic signs and symptoms of Pyloric Stenosis are projectile vomiting (vomitus ejected with great force), poor feeding, and dehydration due to loss of fluids The diagnostic method of choice is ultrasonography, along with detailed medical history[dovemed.com]
Pneumonia
Failure to Thrive
  • The most common presentation was vomiting followed by failure to thrive and weight loss; only two patients had abdominal pain.[afrjpaedsurg.org]
Dyspepsia
  • Case Report A 30-year-old male presented with anorexia, dyspepsia, vomiting, low-grade fever, and weight loss for 2 months.[jmedscindmc.com]
  • Teich S, Mousa HM, Punati J, Di Lorenzo C (2013) Efficacy of permanent gastric electrical stimulation for the treatment of gastroparesis and functional dyspepsia in children and adolescents. J Pediatr Surg 48: 178-183.[scitechnol.com]
Epigastric Tenderness
  • Patients with GOO can present with nausea, post-prandial vomiting, early satiety, dehydration, abdominal bloating, weight loss, and epigastric tenderness.[cancertherapyadvisor.com]
  • She had abdominal distention, sluggish bowel sounds and mild epigastric tenderness.[omicsonline.org]
Peritoneal Disease
  • These modalities are best applied to patients with a greater than 6-month anticipated survival and no peritoneal disease, hepatic metastasis, ascites, diffuse nodal metastases, or proximal gastric outlet obstruction.[healio.com]
Halitosis
  • Trichobezoars subsequently become colonized by bacteria resulting in halitosis.[elsevier.es]
Flushing
  • […] shift of fluid - luminal distension - autonomic responses - Gastrointestinal and Cardiovascular complaints - 20-30 after intake of meals - Nausea vomittings epigastric fullness cramping abdominal pain and explosive diarrhoea - Cardiovascular symptoms- flushing[slideshare.net]
Fear
  • Feeling of unwell Appetite is maintained but fear of pain often prevent patient from eating Weight loss. Abdominal swelling 19. General examinationGeneral examination Wasted Dehydrated Pallor Shock 20.[slideshare.net]
Dizziness
  • […] autonomic responses - Gastrointestinal and Cardiovascular complaints - 20-30 after intake of meals - Nausea vomittings epigastric fullness cramping abdominal pain and explosive diarrhoea - Cardiovascular symptoms- flushing, diaphoresis, palpitations,dizziness[slideshare.net]

Workup

  • The differential diagnoses of childhood gastric outlet obstruction and the possible pitfalls in the diagnostic workup are discussed. The full text of this article hosted at iucr.org is unavailable due to technical difficulties.[onlinelibrary.wiley.com]
  • As part of the initial workup, exclude the possibility of functional nonmechanical causes of obstruction, such as diabetic gastroparesis.[emedicine.medscape.com]
Gastric Varices
  • Malignant adenocarcinoma (second most common 4 ) GIST lymphoma (less commonly than other malignancies as it is a "soft" tumor 1 ) metastases Benign duodenal or gastric peptic ulcers (most common 3,4 ) pancreatic pseudocysts gastric varices granulomatous[radiopaedia.org]
Polyps
  • Endoscopic mucosal resection for gastric polyps Although most pediatric gastric polyps are considered benign lesions, removal of symptomatic polyps are necessary for symptom relief, histological diagnosis, and avoidance of malignant potential.[wjgnet.com]
  • The benign causes of gastric outflow obstruction include pyloric ulcer and gastric polyps in adults, pyloric stenosis and congenital duodenal webs in children, and the ingestion of caustic substances in all age ranges.[medicinenet.com]
  • In contrast, obstruction secondary to a large gastric polyp, gastric bezoar, gastric volvulus, or migration of a gastrostomy tube represents a discrete mechanical problem.[accesssurgery.mhmedical.com]
  • Common causes of GOO include peptic ulcer disease (PUD), gastric polyps, caustic ingestion, duodenal stricture, systemic amyloidosis of the gastrointestinal tract, eosinophillic gastroenteritis and obstruction by gallstones.[wikidoc.org]
  • Symptoms generally occur abruptly with gallstone impaction, prolapse of a large gastric polyp, PEG tube migration and gastric volvulus. Other causes tend to follow a more indolent course.[tropicalgastro.com]
Hepatocellular Carcinoma
  • Pancreatic adenocarcinoma accounted for 13 cases (17%), while gastric adenocarcinoma accounted for 5 cases (7%); less common malignant causes were cholangiocarcinoma, cancer of the ampulla of Vater, duodenal adenocarcinoma, hepatocellular carcinoma, and[mdedge.com]
  • Case Reports A 71-year-old gentleman with past medical history of chronic hepatitis B complicated with multifocal hepatocellular carcinoma underwent living donor liver transplant (LDLT) in our institution.[sciencerepository.org]

Treatment

  • Conservative treatment including PPI should be first line therapy for the gastric outlet obstruction due to peptic ulcer in children. Surgical treatment should be reserved for the patients with failed medical treatment.[nature.com]
  • Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study. Gastrointest Endosc. 2014 Jan;79(1):66-75. doi: 10.1016/j.gie.2013.06.032. Epub 2013 Aug 6.[clinicaltrials.gov]
  • Abstract Today surgery for peptic ulcer disease is largely restricted to the treatment of complications.[ncbi.nlm.nih.gov]
  • Endoscopic treatment offered depended on the cause of GOO.[wjgnet.com]
  • Causation related to ulcers may involve severe pain which the patient may interpret as a heart condition/attack. [1] Treatment of the condition depends upon the underlying cause; it can involve antibiotic treatment when Helicobacter pylori is related[en.wikipedia.org]

Prognosis

  • , prognosis, and additional useful information HERE.[dovemed.com]
  • However, due to her poor prognosis and performance status she was enrolled in hospice and expired six months after her presentation.[omicsonline.org]
  • Endoscopic stenting is an effective, minimally invasive treatment for patients with malignant gastric outlet obstruction and poor prognosis, allowing resumption of oral intake and improving quality of life.[mdedge.com]
  • PrognosisPrognosis Age H pylori reserve Duration Co morbidities Previous surgeries Previous failed Medical therapy for H.pylori Overall prognosis is good with improved surgical and medical therapy 56.[slideshare.net]
  • Other therapies include extracorporeal shock wave lithotripsy, NdYaG laser and laparoscopic removal. 3 After trichobezoar removal, prognosis is good if there is prevention of recurrence. 3 Up to 20 percent of patients have recurrent bezoars. 10 In order[elsevier.es]

Etiology

  • Another less common etiology is a bezoar.[sages.org]
  • GOO has both benign and malignant etiologies, however the history and physical exam findings are similar.[cancertherapyadvisor.com]
  • The purpose of this study is to review the etiology, clinical manifestations, treatment and outcome of the patients in two tertiary referral centers.[nature.com]
  • Objective The purpose of this study was to find the etiologies of GOO, their management options and outcome in Tribhuvan University Teaching Hospital.[nepjol.info]
  • Pathology Etiology Gastric outlet obstruction can be due to malignant or benign causes.[radiopaedia.org]

Epidemiology

  • […] and Demographics The epidemiology of GOO is as follows: [21] [22] The incidence of peptic ulcer disease (which is the most common benign cause of GOO) is approximately 10-19 per 100,000 individuals worldwide.[wikidoc.org]
  • Gastric cancer epidemiology and risk factors. J Clin Epidemiol. 2003;56(1):1-9. 2. Jeurnink SM, van Eijck CH, Steyerberg EW, et al. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review.[healio.com]
  • Epidemiology of extrapulmonary tuberculosis. A comparative analysis with pre-AIDS era. Chest 1991;99:1134-8. 7. Khan FY, AlAni A, Al-Rikabi A, Mizrakhshi A, Osman Mel-M.[jmedscindmc.com]
  • Epidemiology The incidence of GOO has been reported to be less than 5% in patients with PUD, which is the leading benign cause of the problem.[emedicine.medscape.com]
  • Epidemiology The incidence of gastric outlet obstruction is not known precisely.[tropicalgastro.com]
Sex distribution
Age distribution

Pathophysiology

  • Gastric outlet obstruction (GOO, also known as pyloric obstruction) is not a single entity; it is the clinical and pathophysiological consequence of any disease process that produces a mechanical impediment to gastric emptying. en_US dc.language.iso en[erepository.uonbi.ac.ke]
  • Gastric outlet obstruction (GOO) is not a single disorder; it is a group of clinical and pathophysiological consequence of many disease processes that produce a mechanical barrier to gastric emptying.[encyclopedia2.thefreedictionary.com]
  • Takahashi T (2003) Pathophysiological significance of neuronal nitric oxide synthase in the gastrointestinal tract. J Gastroenterol 38: 421-430.[scitechnol.com]
  • Pathophysiology Intrinsic or extrinsic obstruction of the pyloric channel or duodenum is the usual pathophysiology of GOO; the mechanism of obstruction depends upon the underlying etiology.[emedicine.medscape.com]
  • Malignant Tumours of the stomach, including adenocarcinoma (and its linitis plastica variant), lymphoma, and gastrointestinal stromal tumours src: images.slideplayer.com Pathophysiology In a peptic ulcer it is believed to be a result of edema and scarring[tipstovoid.blogspot.com]

Prevention

  • In order to prevent closure of the gastrostomy, a Foley catheter was immediately put in place. Several hours later the patient presented with vomiting.[revistagastroenterologiamexico.org]
  • […] the pyloric sphincter, which controls the flow of partially digested food out of the stomach and into the duodenum Pyloric Stenosis is the thickening of the muscle layer of the pyloric region resulting in the narrowing of the pyloric sphincter, which prevents[dovemed.com]
  • Early recognition of the tube migration leading to obstructive symptoms in a clinically appropriate scenario prevents further complications such as ulceration, necrosis and avoids surgical intervention.[journalmc.org]
  • ., 2014 69 F End colostomy Laparotomy Stoma transposition Preventive mesh of the new stoma Yes Discharge Bull et al., 2017 85 F Loop colostomy Laparoscopy convert to laparotomy Stoma transposition No Discharge Andrade et al., 2017 (current report) 77[academic.oup.com]
  • Support may include: IV fluids—for hydration and electrolytes Removal of trapped solids, liquids, or gasses from the stomach—a tube is passed through the nose to the stomach Prevention If you have peptic ulcer disease, follow your care plan.[winchesterhospital.org]

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