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DR.EDWINA VASANTHA,M.S.,D.G.O
• GOO is the clinical and pathophysiological
consequence of any symptom complex that
produces a mechanical impediment to gastric
emptying.
HISTORY
• AGE :20-45 years with peak 30-35 years
• Abdominal pain
site:epigastric and left hypochondrial pain
relationship to food: food - pain -
relief=du
food – pain =gu
relieved by alkali,milk
association with time of the day
h/o radiation to the back(? Pancreas
penetration)
generalised pain(perforation)
• Anorexia,nausea
• Early satiety
• Vomiting- characteristic unpleasant
-copious
-projectile
-non bilous,food taken several hours
to days ago
• Feeling of unwell
• Weight loss
• Abdominal swelling
EXAMINATION
• Chronically ill looking
• Wasted,dehydrated
• Pale
• May be in shock
• Epigastric /left or right hypochondrial
tenderness
• Distended abdomen
• Visible gastric peristalsis
• hepatosplenomegaly
• Succussion splash
• Auscultopercussion test-to look for stomach
dialatation
• Internal pelvic,per rectal examination
• Vitals
• Lymph nodal enlargement- left supraclavicular
INVESTIGATIONS
• To stabilise patient
-complete haemogram
-serum electrolytes,
-arterial blood gases
-urinalysis
• To confirm diagnosis
-plain x-ray abdomen erect
-gastric function tests:>400ml resting juice
aspirated shows presumptive diagnosis of GOO
-endoscopy and biopsy
-barium meal:findings
markedly dialated stomach with a lot
of residue
gastritis,stasis
chronic cicatrised ulcer,diverticula
trifoliate deformity of duodenal cap
pyloric opening narrowed or total
obstruction
• Detection of H.pylori
-Non invasive
serology
carbon labelled urea breath test
-invasive
rapid ureasetest
histology and culture
• Differential diagnosis
PUD
Gastric polyps
Ingestion of caustics
Pyloric stenosis; mostly fisrt borne male child
Congenital duodenal webs
Gallstone obstruction (Bouveret syndrome)
Pancreatic pseudocysts
bezoars
Cast syndrome(superior mesentric artery
Malignancy
pancreatic cancer
ampullary cancer
duodenal cancer
cholangiocarcinoma
gastric cancer
metastases to gastric outlet from other
primary
• TREATMENT
General measures
resuscitation : IVF
urethral catheter
nasogastric tube
correction of electrolyte
imbalance ideally under ECG monitoring
anaemia correction
Antisecretory therapy
Non operative : warm saline lavage
H.pylori eradication
Invasive :endoscopic balloon dialatation
Operative measures
highly selective
vagotomy+GJ+H.pylori eradication
truncal/selective vagotomy
+Billroth II +kocherisation +HP Eradication
TV/SV+
Antrectomy+GJ/GD+Kocherisation+HP
eradication
OBSTRUCTING TYPES-distal
gastrectomy+TV+GJ+HPE
• POST OP COMPLICATIONS
immediate:primary haemorrhage
injury to contiguous strictures
aneasthetic complications
early: postgastrecrtomy syn
i)early dumping: 20-30 mins after
ingestion ofmeal
both GI and cardiovascular
symptoms
Mgt-pt.informed preop
dietary modification,long
acting somatostatin analogue,jejunal 20cm
isoperistaltic loop interposition,jejunal 10cm
antiperistaltic loop interposition
2) Late dumping: due to hypoglycaemia
Mgt:small meals,less
carbohydrates,antiperistaltic loop