Pyloric Stenosis, Pyloric Obstruction, Stomach Outlet Obstruction, Causes, S/S, Treatment

Pyloric Stenosis, Pyloric Obstruction, Stomach Outlet Obstruction;
A peptic ulcer in the region of pylorus may lead to gastric outlet obstruction due to:
1. Oedema
2. Spasm
3. Fibrous stricture
4. Duodenal ulcer
5. Carcinoma of antrum
6. External compression from carcinoma of the pancreas.

Signs Symptoms and Clinical Features of Pyloric Stenosis

• Long History of Peptic Ulcer:

A long history of peptic ulcer without symptoms of peptic ulcer, gastric outlet obstruction is likely to have a pyloric carcinoma.
When the cause is a peptic ulcer, nausea and vomiting become prominent.

• Vomiting:- It gives striking relief to the patient Vomitus contains food particles which have been eaten even 24 hours or more previously.
• Alkalosis:-Alkalosis develops if a large amount of HCI is lost in vomiting, as occurs particularly in obstruction due to duodenal ulcer.
• Wasting due to undernourishment.
• Dehydration
• Succussion splash: Succussion splash may be elicited four hours or more after the last meal or drink. While in the normal person splashing occurs for less than an hour after meals because gastric emptying is rapid.
• Visible gastric peristalsis - diagnostic of gastric outlet obstruction.

Investigation of Pyloric Stenosis:-

1. Aspiration of stomach contents:
If the volume of aspirated contents is more than 100 ml after fasting overnight, or the aspirate contains food residue, the diagnosis is confirmed.

2. Barium meal:
Barium meal shows:

• An increase in the fasting residue of stomach
• Dilatation of stomach with or without excessive peristalsis.
• A lesion at or near the pylorus Delayed gastric emptying

3. Endoscopy:
Endoscopy demonstrates the cause & degree of obstruction.

4. Serum Electrolytes:
Serum electrolytes show: depletion of electrolytes

5. Aspiration

6. ABGs:
Perform and Interpret ABGs (arterial blood gasses) to check alkalosis

Treatment of Pyloric obstruction/stomach outlet obstruction

• Nothing per oral (NPO)
• 2-4 hourly aspiration for 3-4 days. If the volume of aspirate has decreased, fluids by mouth can be allowed.
• I/V fluids for rehydration
• Multivitamins '

The majority of patients will be greatly improved by these methods, giving opportunity to complete investigations and to make the patient fit for subsequent surgery if needed.