Gastric Outlet Obstruction

Gastric Outlet Obstruction is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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

Etiology

  • 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

Description

  • 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

Etiology

  • 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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