Gastric Outlet Obstruction, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Gastric Outlet Obstruction, Diagnosis and Treatment and Related DiseasesGastric outlet obstruction is a disorder where there is an obstruction in the outlet opening of the stomach (Pylorus), blocking the entrance of ingested food coming from the stomach to the duodenumCausesIn children, gastric outlet obstruction can have two possible causes:A. Mechanical obstruction happens when the exit to the stomach is narrowed but the gastric nervous and muscular systems are intact.
The causes of mechanical obstruction can be perinatal or postnatal. The perinatal causes mainly are anatomical anomalies as:1. Antral webs, 2. Congenital gastric atresias, 3. Pyloric stenosis, 4. Annular pancreas or5. Gastric duplication cysts or6. Hyper-trophic pyloric stenosis, Most of these manifest at an older age. The postnatal causes vary from:1. More frequent peptic ulcer disease and healing burns from caustic ingestion2.
More uncommon causes as eosinophilic gastroenteritis or Crohn's disease, both infectious and noninfectious. The often implicated drugs are:1. Non-steroidal anti-inflammatory drugs2. Macrolide3. Fluoxetine in pregnancy4. Opiates5. LipitorThe frequent causes of luminal obstruction are:1. Gastric bezoar2. Percutaneous endoscopic gastrostomy tube migration3. Malrotation4. Gastric polyps5. Diaphragmatic hernia6.
Acute or chronic pancreatitis causing external compression, 7. Pancreatic pseudocyst, 8. Hematomas (traumatic or Henoch-Schonlein purpura), 9. Duodenal hamartoma, 10. Extrinsic band, 11. LymphomasB. Functional causes of gastroparesis are neurological causes that could be:1. Acute, due toa. Viral infections, b. Electrolyte anomaliesc. Surrounding tissue inflammation2. Chronic as seen ina. Uncontrolled diabetesb.
Intrinsic muscular diseasesSymptomsVomitingEpigastric painConstipationLoss of weightHypo-kalemia and metabolic acidosisSatietyAbnormal enlargement of the stomachDiagnosis:Physical AssessmentAn abdominal X-rayEndoscopic gastrostomyAbdominal ultrasoundCT scan abdomenElectrolytes levelsTreatment:Proton pump inhibitorsNasogastric suctionElectrolytes replacementSurgical treatment:Antrectomy is the surgical removal of the antrum, the part of the stomach just inside the pylorusVagotomy involves cutting one or more branches of the Vagus nerve to reduce gastric acidBillroth I is the removal of the Pylorus followed by the connection of the proximal stomach to the duodenum.
The operation is for the treatment of peptic ulcer and gastric cancerGastrojejunostomy or Billroth II is a surgical procedure that develops a connection between the jejunum (the middle part of the small intestine between the duodenum and ileum) and the stomachParenteral NutritionSupplementary nutrients through Total Parenteral Nutrition (TPN) or Distal feeding tube are helpful among patients with gastric outlet obstruction since their nutritional status normally gets worse.
Children:In children, the doctors attempt to treat most cases conservatively. The large percentage of these patients manifest with significant esophageal and gastric irritation due to obstruction of flow and acid refluxThey hence need adjunct medical therapy with:1. Proton pump inhibitors, 2. Sucralfate or3. Steroids. With an advanced endoscopic approach the doctors can do:1. Pneumatic dilations, 2.
Placement of stents, 3. Ablation of antral webs or4. Injection of Botox, But most children require surgical interventions with1. Antral web resection, 2. Partial gastrectomy, 3. Antrectomy or4. Billroth II operation. The use of stents to allow passage of food is a new tr...