Gastric Outlet Obstruction
Gastric Outlet Obstruction is a topic covered in the
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Basics
- Any process impeding the passage of gastric contents into the duodenum
- Causes not limited to gastric pathology and may be duodenal or extraluminal in origin
- Regardless of exact cause, gastric outlet obstruction characteristically leads to nausea and nonbilious vomiting
- Persistent vomiting may lead to dehydration, electrolyte and acid–base derangements:
- Chronic symptoms may lead to weight loss, malnutrition, failure to thrive
- Hypokalemic, hypochloremic metabolic alkalosis is classic finding
- Neoplasms (most common cause in adults)
- Intrinsic or extrinsic neoplasms (pancreatic, gastric lymphoma, duodenal, gallbladder) causing compression at pylorus or proximal duodenum
- Peptic ulcer disease (PUD), no longer most common cause in adults, with treatment of Helicobacter pylori and use of H2 blockers
- Pyloric stenosis (most common pediatric cause): Incidence 2–5/1,000
- Postoperative complications, especially from gastric surgeries (e.g., edema, scarring, stricture, or hyperplasia of pylorus or duodenum)
- Mechanical causes: Gastric volvulus, polyps, bezoars, duplication cysts
- Edema, scarring, strictures/webs, or hyperplasia of pylorus or duodenum from various causes (e.g., caustic injury, chronic pancreatitis)
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Basics
- Any process impeding the passage of gastric contents into the duodenum
- Causes not limited to gastric pathology and may be duodenal or extraluminal in origin
- Regardless of exact cause, gastric outlet obstruction characteristically leads to nausea and nonbilious vomiting
- Persistent vomiting may lead to dehydration, electrolyte and acid–base derangements:
- Chronic symptoms may lead to weight loss, malnutrition, failure to thrive
- Hypokalemic, hypochloremic metabolic alkalosis is classic finding
- Neoplasms (most common cause in adults)
- Intrinsic or extrinsic neoplasms (pancreatic, gastric lymphoma, duodenal, gallbladder) causing compression at pylorus or proximal duodenum
- Peptic ulcer disease (PUD), no longer most common cause in adults, with treatment of Helicobacter pylori and use of H2 blockers
- Pyloric stenosis (most common pediatric cause): Incidence 2–5/1,000
- Postoperative complications, especially from gastric surgeries (e.g., edema, scarring, stricture, or hyperplasia of pylorus or duodenum)
- Mechanical causes: Gastric volvulus, polyps, bezoars, duplication cysts
- Edema, scarring, strictures/webs, or hyperplasia of pylorus or duodenum from various causes (e.g., caustic injury, chronic pancreatitis)
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