This document describes gastric outlet obstruction (GOO), including its causes, symptoms, examinations, investigations, differential diagnosis, and treatment options. GOO is caused by any mechanical impediment to gastric emptying. Common symptoms include abdominal pain, nausea, vomiting of undigested food, early satiety, and weight loss. Investigations may include blood tests, imaging like x-rays and endoscopy, and gastric function tests. Treatment depends on the underlying cause but may involve resuscitation, antisecretory drugs, endoscopic procedures, or surgery like vagotomy with pyloroplasty or gastric resection. Post-operative complications can include bleeding, strictures, dumping syndrome, and duodenal blowout.

1. GASTRIC OUTLET OBSTRUCTION
DR.EDWINA VASANTHA,M.S.,D.G.O

2. • 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

3. 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

4. • Feeling of unwell
• Weight loss
• Abdominal swelling
EXAMINATION
• Chronically ill looking
• Wasted,dehydrated
• Pale
• May be in shock
• Epigastric /left or right hypochondrial
tenderness

5. • 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

6. 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

7. -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

8. carbon labelled urea breath test
-invasive
rapid ureasetest
histology and culture

9. • 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

10.  Malignancy
pancreatic cancer
ampullary cancer
duodenal cancer
cholangiocarcinoma
gastric cancer
metastases to gastric outlet from other
primary

11. • 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

12. 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

15. • 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

16. 2) Late dumping: due to hypoglycaemia
Mgt:small meals,less
carbohydrates,antiperistaltic loop
• duodenal blow out:4-5th post op day,life
threatening, mgt;fluid and electrolyte
correction,enteroentostomy

25. Thank you