Gastric outlet obstruction

Gastric outlet obstruction

Gastric outlet obstruction is a medical condition manifested by obstruction at the level of the pylorus, which is the outlet of the stomach.

Patients with gastric outlet obstruction may develop vomiting, which may be projectile but non-bilious in nature, nausea or abdominal pain. An unusual finding by the treating physician that may lead to the diagnosis is the "succussion splash", a splash-like sound heard over the stomach in the left upper quadrant of the abdomen on shaking the patient, with or without the stethoscope. The diagnosis is typically made by X-ray, which will show an absent air bubble in the stomach, or by CT scan.

Causes of gastric outlet obstruction include peptic ulcer disease; tumours of the stomach, including adenocarcinoma (and its linitis plastica variant), lymphoma, and gastrointestinal stromal tumours; infections, such as tuberculosis; and infiltrative diseases, such as amyloidosis. A rare cause of gastric outlet obstruction is obstruction with a gallstone, also termed "Bouveret's syndrome". Pyloric stenosis is a cause of gastric outlet obstruction in neonates.

Treatment of gastric outlet obstruction depends on the cause, but may include either surgery or treatment with medications, such as proton pump inhibitors. In patients with peptic ulcer disease, the oedema will usually settle with conservative management with nasogastric suction, replacement of fluids and electrolytes and proton pump inhibitors. Surgery is rarely required nowadays.

Metabolic alkalosis may develop as a result of loss of acid.

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