Gastric Outlet Obstruction, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

This book describes Gastric Outlet Obstruction, Diagnosis and Treatment and Related Diseases
Gastric outlet obstruction is a disorder where there is an obstruction in the outlet opening of the stomach (Pylorus), blocking the entrance of ingested food coming from the stomach to the duodenum
Causes
In children, gastric outlet obstruction can have two possible causes:
A. Mechanical obstruction happens when the exit to the stomach is narrowed but the gastric nervous and muscular systems are intact.
The causes of mechanical obstruction can be perinatal or postnatal.
The perinatal causes mainly are anatomical anomalies as:
1. Antral webs,
2. Congenital gastric atresias,
3. Pyloric stenosis,
4. Annular pancreas or
5. Gastric duplication cysts or
6. Hyper-trophic pyloric stenosis,
Most of these manifest at an older age.
The postnatal causes vary from:
1. More frequent peptic ulcer disease and healing burns from caustic ingestion
2. More uncommon causes as eosinophilic gastroenteritis or Crohn’s disease, both infectious and noninfectious.
The often implicated drugs are:
1. Non-steroidal anti-inflammatory drugs
2. Macrolide
3. Fluoxetine in pregnancy
4. Opiates
5. Lipitor
The frequent causes of luminal obstruction are:
1. Gastric bezoar
2. Percutaneous endoscopic gastrostomy tube migration
3. Malrotation
4. Gastric polyps
5. Diaphragmatic hernia
6. Acute or chronic pancreatitis causing external compression,
7. Pancreatic pseudocyst,
8. Hematomas (traumatic or Henoch-Schonlein purpura),
9. Duodenal hamartoma,
10. Extrinsic band,
11. Lymphomas
B. Functional causes of gastroparesis are neurological causes that could be:
1. Acute, due to
a. Viral infections,
b. Electrolyte anomalies
c. Surrounding tissue inflammation
2. Chronic as seen in
a. Uncontrolled diabetes
b. Intrinsic muscular diseases
Symptoms
Vomiting
Epigastric pain
Constipation
Loss of weight
Hypo-kalemia and metabolic acidosis
Satiety
Abnormal enlargement of the stomach
Diagnosis:
Physical Assessment
An abdominal X-ray
Endoscopic gastrostomy
Abdominal ultrasound
CT scan abdomen
Electrolytes levels
Treatment:
Proton pump inhibitors
Nasogastric suction
Electrolytes replacement
Surgical treatment:
Antrectomy is the surgical removal of the antrum, the part of the stomach just inside the pylorus
Vagotomy involves cutting one or more branches of the Vagus nerve to reduce gastric acid
Billroth I is the removal of the Pylorus followed by the connection of the proximal stomach to the duodenum.
The operation is for the treatment of peptic ulcer and gastric cancer
Gastrojejunostomy or Billroth II is a surgical procedure that develops a connection between the jejunum (the middle part of the small intestine between the duodenum and ileum) and the stomach
Parenteral Nutrition
Supplementary nutrients through Total Parenteral Nutrition (TPN) or Distal feeding tube are helpful among patients with gastric outlet obstruction since their nutritional status normally gets worse.
Children:
In children, the doctors attempt to treat most cases conservatively.
The large percentage of these patients manifest with significant esophageal and gastric irritation due to obstruction of flow and acid reflux
They hence need adjunct medical therapy with:
1. Proton pump inhibitors,
2. Sucralfate or
3. Steroids.
With an advanced endoscopic approach the doctors can do:
1. Pneumatic dilations,
2. Placement of stents,
3. Ablation of antral webs or
4. Injection of Botox,
But most children require surgical interventions with
1. Antral web resection,
2. Partial gastrectomy,
3. Antrectomy or
4. Billroth II operation.
The use of stents to allow passage of food is a new treatment

• Language: English
• Publisher: Kenneth Kee
• Release date: Sep 7, 2018
• ISBN: 9780463319291

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Gastric Outlet Obstruction,

A

Simple

Guide

To

The Condition,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2018 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Gastric Outlet Obstruction, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What The patient Need to Treat Gastric Outlet Obstruction)

This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog: http://afamilydoctorstale.blogspot.com.

This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Gastric outlet obstruction

What is Gastric Outlet Obstruction?

Gastric outlet obstruction is a disorder where there is an obstruction in the outlet opening of the stomach (Pylorus), blocking the entrance of ingested food coming from the stomach to the duodenum.

What are the Causes of Gastric Outlet Obstruction?

Gastric Outlet Obstruction Causes

Children

In children, gastric outlet obstruction can have two possible causes, mechanical and functional.

A. Mechanical obstruction happens when the exit to the stomach is narrowed but the gastric nervous and muscular systems are intact.

The causes of mechanical obstruction can be perinatal or postnatal.

The perinatal causes mainly are anatomical abnormalities as:

1. Antral webs,

2. Congenital gastric atresias,

3. Pyloric stenosis,

4. Annular pancreas or

5. Gastric duplication cysts or

6. Hyper-trophic pyloric stenosis,

Most of these manifest at an older age.

On the other hand, the postnatal causes vary from:

1. More frequent peptic ulcer disease or drug-induced gastric ulcers and healing burns from caustic ingestion

2. More uncommon causes as eosinophilic gastroenteritis or Crohn’s disease and other granulomatous diseases, both infectious