The patient presents with symptoms highly suggestive of a blockage in the stomach or duodenum, leading to delayed gastric emptying.
Diagnosis of Gastric Outlet Obstruction
The key symptoms point towards Gastric outlet obstruction:
- Periodic upper abdominal pain, especially early morning pain, can occur due to gastric stasis.
- Projectile vomiting: This is a hallmark sign, indicating significant pressure buildup in the stomach.
- Non-bilious vomiting with undigested food: This specifically suggests the obstruction is distal to the ampulla of Vater (where bile enters the duodenum), meaning the stomach contents cannot pass into the small intestine.
- Dehydration and weight loss: These are consequences of persistent vomiting and inability to retain food and fluids.
Evaluating Other Options
While other conditions can cause abdominal pain and vomiting, they fit the clinical picture less precisely:
- Carcinoma stomach: Although possible, the specific nature of the vomiting (projectile, undigested food) is more characteristic of a mechanical obstruction like outlet obstruction, which can be caused by ulcers, inflammation, or sometimes cancer. However, the presentation leans more towards obstruction itself.
- Gastro-oesophageal reflux with oesophagitis: Typically causes heartburn and regurgitation, not projectile vomiting of undigested food.
- Superior mesenteric artery syndrome: This causes duodenal compression, usually presenting after significant weight loss. While it causes vomiting, the classic symptoms here align more directly with gastric stasis.
Therefore, the constellation of symptoms, particularly the projectile vomiting of undigested food in a patient with upper abdominal pain and signs of poor intake, strongly indicates Gastric outlet obstruction.
Important Questions from Stomach
- A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = $106/min$, BP = $100/70$ mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size $13 \times 8$ cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is
- The most common metabolic abnormality associated with gastric outlet obstruction is
- Which of the following statements about peptic ulcers is correct?
- A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = $106$/min, BP = $100/70$ mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size $13 \times 8$ cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is
- All of the following are sequelae of peptic ulcer surgery EXCEPT:
