Gastric outlet obstruction


Leading cause of Gastroparesis is


A. Norwalk virus infection
B. Bariatric procedures
C. Diabetes mellitus
D. Amyloidosis



The most common cause of gastric outlet obstruction is


A. Peptic ulceration
B. Perforation of duodenal ulcer
C. Pancreatic adenocarcinoma
D. Distal gastric cancer



Following are the features of gastric outlet obstruction except


A. Hypocalcemia
B. Hypochloremic metabolic alkalosis
C. Hypergastrinemia
D. Hyperkalemia



Not true regarding diagnosis of gastric outlet obstruction

A. Absence of contrast in the small intestine in barium meal X ray
B. CT scan not useful
C. Endoscopy should be performed after fasting for over 4 hours
D. Hypochloremic alkalosis is a significant finding



Benign gastric outlet obstruction is best treated by


A. Intraluminal stent insertion
B. Gastrojejunostomy
C. Endoscopic balloon dilation
D. Pyloroplasty



Which of the following gastric polyp has high malignant potential

A. Gastrointestinal stromal tumor
B. Neuroendocrine tumor
C. Hyperplastic polyp
D. Fundic gland polyp


In short


Benign gastric outlet obstruction

In benign GOO caused by PUD, conservative management should be tried first, including acid suppression, NSAID avoidance, testing for and treating H. pylori.


Severe vomiting

Hypokalemia and hypochloremic metabolic alkalosis are often present from severe vomiting. Increased serum gastrin levels can be seen as abdominal distension induces gastrin release.


Metabolic abnormality of hypochloremic alkalosis

The metabolic abnormality of hypochloremic alkalosis is usually only seen with peptic ulcer disease and should be treated with isotonic saline with potassium.


Endoscopy

Endoscopy is generally needed to confirm and establish the specific cause of the obstruction. A nasogastric tube should be inserted and suction should be done before endoscopy to reduce the risk of aspiration.


Saline load test

Following gastric decompression, to further evaluate mechanical outlet obstruction, a saline load test can be helpful. The saline load (750 ml) is emptied into a patient’s stomach through a nasogastric tube. If more than 400 mL gastric contents are aspirated after 30 minutes, it is considered a positive test.


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