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]
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]
Gastric outlet obstruction is the most common presentation in most cases. [encyclopedia2.thefreedictionary.com]
Entire Body System
- Pain
HistoryHistory AGE:20-45 years with peak 30-35 years Known or suspected case of chronic PUD Epigastric and Lt hypochondrial pain : -relieved by alkali, food. [slideshare.net]
Sign In A 51-year-old woman with a history of hypertension and chronic constipation presented with abdominal pain of 2 weeks' duration. The pain was continuous, worsened with eating, was associated with nausea, and radiated to her back. [nejm.org]
A 60-year-old woman presents with a several-week history of worsening non-bilious emesis and epigastric abdominal pain. [accesssurgery.mhmedical.com]
The most common symptoms include abdominal pain, nausea, vomiting, early satiety, anorexia, and weight loss. 3,5 They represent an uncommon cause of abdominal mass. [elsevier.es]
New York Presbyterian Queens Introduction: Gastric outlet obstruction (GOO) is a blockage in the outflow of the stomach that is characterized by abdominal pain and postprandial emesis of undigested food. [sages.org]
- Inflammation
With pancreatitis, intense peri-pancreatic inflammation and edema can result in inflammation and fibrosis of the adjacent duodenum. [accesssurgery.mhmedical.com]
Computed Tomography (CT) showed a distended stomach, pyloric inflammation (Figure 1B) and partial gastric outlet obstruction (GOO) (Figure 1C). Subsequent EGD showed pyloric stenosis with partially obstructing duodenal bulb ulceration. [imagejournals.org]
The etiology of peptic ulcers included non-steroid anti-inflammation drugs (NASIDs) ingestion (2), Helicobacter pylori and unknown (1). All patients manifested as post-prandial vomiting. [nature.com]
The stones enter the small bowel via cholecysto-enteric fistula which is created by chronic inflammation of the adherent biliary system and bowel walls causing necrosis [ 2 Nickel F, Muller-Eschner MM, Chu J, et al. [tandfonline.com]
Intrinsic obstruction : Conditions involving infiltration, scar formation or inflammation of antrum and the pylorus may lead to intrinsic obstruction and GOO. [wikidoc.org]
- Asymptomatic
[…] obstruction, 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 [encyclopedia2.thefreedictionary.com]
Conclusion The PCI is a rare case, mostly silent and asymptomatic, and the majority of its cases discovered by chance while the patient is investigated for other complaints or other diseases of the abdomen. [ccij-online.org]
In an adult series, 25 patients with proven GOO secondary to PUD were managed with EBD using TTS balloons, 80 % of patients remained asymptomatic (follow-up: median 9 mo, range 2-24 mo)[ 39 ]. [wjgnet.com]
- Surgical Procedure
The two surgical procedures were compared on the basis of best effectiveness of the technique in restoring the gastric outlet obstruction, improvement in luminal diameter post-operatively, development of adhesions, ease in surgery, healing at the operation [encyclopedia2.thefreedictionary.com]
Types of surgical procedures The types of surgical procedures performed in cases of GOO are as follows: [35] [36] [37] Vagotomy and antrectomy, gastrojejunostomy ( vagotomy and antrectomy with Billroth II reconstruction), balloon dilatation, pylorotomy [wikidoc.org]
A surgical procedure to join the stomach to the upper small bowel (gastrojejunostomy), thereby, diverting food around the blockage can be performed. [cochranelibrary.com]
- Swelling
Causes The blockage is caused by problems of nearby tissue such as: Swelling from peptic ulcer (most common cause) Swelling from nearby pancreas Abnormal growth of tissue such as: Scar tissue due to a peptic ulcer A cancer growth Risk Factors Factors [winchesterhospital.org]
Abdominal swelling 19. General examinationGeneral examination Wasted Dehydrated Pallor Shock 20. Epigastric / Rt hypochondrial tenderness Distended abdomen Visible gastric peristalsis Succussion splash Goldstein saline load test 21. [slideshare.net]
Respiratoric
- Dyspnea
The other general clinical findings were the dyspnea, chest pain, and no fever. The patient was admitted in the department of general surgery. [ccij-online.org]
Gastrointestinal
- Vomiting
Nausea and non-bilious vomiting are the characteristic symptoms [ 2 ]. [scitechnol.com]
Easy satiety Vomiting: -characteristic unpleasant -copious -projectile -Non bilious -Food taken several days ago. 18. Feeling of unwell Appetite is maintained but fear of pain often prevent patient from eating Weight loss. [slideshare.net]
Abstract Most of the gastric outlet obstruction symptoms like vomiting and abdominal distension were caused by congenital anatomical abnormality in a neonate. [synapse.koreamed.org]
A 72-year-old woman presents to the emergency department with progressive nausea and vomiting. One week earlier, she developed early satiety and nausea with vomiting after eating solid food. [mdedge.com]
Patients with GOO can present with nausea, post-prandial vomiting, early satiety, dehydration, abdominal bloating, weight loss, and epigastric tenderness. [cancertherapyadvisor.com]
- Abdominal Pain
New York Presbyterian Queens Introduction: Gastric outlet obstruction (GOO) is a blockage in the outflow of the stomach that is characterized by abdominal pain and postprandial emesis of undigested food. [sages.org]
A 72-year-old female presented with complaints of nausea and abdominal pain after recent PEG placement. [journalmc.org]
pain, and early satiety. [mdedge.com]
The most common symptoms include abdominal pain, nausea, vomiting, early satiety, anorexia, and weight loss. 3,5 They represent an uncommon cause of abdominal mass. [elsevier.es]
Sign In A 51-year-old woman with a history of hypertension and chronic constipation presented with abdominal pain of 2 weeks' duration. The pain was continuous, worsened with eating, was associated with nausea, and radiated to her back. [nejm.org]
- Nausea
A 72-year-old woman presents to the emergency department with progressive nausea and vomiting. One week earlier, she developed early satiety and nausea with vomiting after eating solid food. [mdedge.com]
Patients with GOO can present with nausea, post-prandial vomiting, early satiety, dehydration, abdominal bloating, weight loss, and epigastric tenderness. [cancertherapyadvisor.com]
A 72-year-old female presented with complaints of nausea and abdominal pain after recent PEG placement. [journalmc.org]
The pain was continuous, worsened with eating, was associated with nausea, and radiated to her back. She reported no vomiting, fever, diarrhea, or weight loss, and her vital signs were normal. [nejm.org]
No matter the cause, clinical presentation usually involves vomiting, nausea, malnutrition, dehydration, and associated electrolyte abnormalities. [healio.com]
- Early Satiety
Other commonly seen symptoms include early satiety, abdominal distention, and weight loss. 7 Initially, patients have intermittent symptoms that then progress until the obstruction is complete. Malnutrition is a ... [accesssurgery.mhmedical.com]
She noted early satiety, a 15 lbs weight loss (last 3 months) and constipation. Examination revealed a malnourished woman with temporal and supraclavicular wasting. [imagejournals.org]
Patients with GOO can present with nausea, post-prandial vomiting, early satiety, dehydration, abdominal bloating, weight loss, and epigastric tenderness. [cancertherapyadvisor.com]
Major symptoms are nausea, vomiting, early satiety or postprandial fullness, bloating, and abdominal or epigastric pain. de Ja, natürlich, Liebling en Between 8/91–2/93 a total of 18 self-expanding metal stents were implanted in 16 patients with obstructions [de.glosbe.com]
- Delayed Gastric Emptying
Gastrograffin meal: Showed dilated stomach, delayed gastric emptying ( Figure 5 ), no gastro esophageal reflux. Figure 5: Showing delayed gastric emptying after about 1 hour of contrast seen in the stomach. [scitechnol.com]
[…] several disadvantages, including significant morbidity and mortality rates, and is frequently associated with delayed gastric emptying. en Gastric outlet obstruction is a clinical syndrome defined by voluminous vomiting, and loss of weight in long-term [de.glosbe.com]
If several hours after eating you can hear a “splash-like” noise, it suggests delayed gastric emptying which may be due to GOO. [cancertherapyadvisor.com]
Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg. 1987 Jul. 122(7):827-9. [Medline]. Abdel-Salam WN, Katri KM, Bessa SS, et al. [medscape.com]
Skin
- Ulcer
[…] en Symptomatic gastric outlet obstruction remains a special indication for elective ulcer operation with gastric resection and vagotomy being available as alternative options for Intervention. 55 patients with chronic duodenal ulcers complicated by symptomatic [de.glosbe.com]
Available at: http://www.merckmanuals.com/professional/gastrointestinal-disorders/gastritis-and-peptic-ulcer-disease/peptic-ulcer-disease. Accessed December 12, 2018. Stomach Ulcer-Complications. NHS Choices website. [winchesterhospital.org]
[…] and chronic peptic ulcer disease. [mdedge.com]
In rare cases, peptic ulcer penetration requires surgery. Approximately 1-2% of patients with peptic ulcer disease develop gastric outlet obstructions (GOO), and about 80% of GOO due to peptic ulcer disease are caused by duodenal ulcers. [ncbi.nlm.nih.gov]
Obstructing peptic ulcers results of treatment. Arch Surg. 1967;94:724-9. Yogiram B, Chowdary NV. Duodenal (ulcer) stenosis in Andhra Pradesh. A 10 years study. Ind. J. Surg. 1983:12-6. Kozoll DD, Meyer KA. Obstructing gastro duodenal ulcer. [ijsurgery.com]
Musculoskeletal
- Osteoporosis
Metabolic Disturbances - Iron deficiency Anaemia - Impairment of Vitamin B12 metabolism - Decreased absorption of calcium leading to osteomalicia and osteoporosis 46. [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]
Treatment
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]
Endoscopic treatment offered depended on the cause of GOO. [wjgnet.com]
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]
Patients' demography, etiologies of GOO, treatment given and their outcome were analysed. Results Thirty two patients (73%) were male and 12 (27%) were female with M:F ratio of 2.7:1. [nepjol.info]
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]
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]
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]
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]
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]
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]
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]
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]
Foley catheters are easily available and some may use it to prevent gastrostomy closure after accidentally PEG tube extraction (3). [scielo.isciii.es]
Ramia-Angel et al., 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]