Clinical features

Clinical features

In benign gastric outlet obstruction, there is usually a long history of peptic ulcer disease. The vomitus is characteristically of undigested food and is totally lacking in bile. Weight loss is a feature, and the patient appears unwell and dehydrated. On examination the distended stomach may be visible and a succussion splash may be audible. Gastric outlet obstruction /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Gastric outlet obstruction is most commonly associated with longstanding peptic ulcer disease and gastric cancer The metabolic abnormality of hypochloraemic alkalosis is usually only seen with peptic ulcer disease and should be treated with isotonic saline with potassium Endoscopic biopsy is essential to exclude malignancy Aggressive medical therapy for peptic ulcer disease often leads to resolution Endoscopic dilatation of the gastric outlet may be effective in benign stenosis Operation is frequently required, with a drainage procedure being performed for benign disease or appropriate resection of malignancy

Clinical features

The features of advanced gastric cancer are usually obvious. Unfortunately , early gastric cancer has no specific features to distinguish it from benign dyspepsia and a high index of suspicion is necessary . In advanced cancer, early satiety , bloating, distension and vomiting may occur. The tumour frequently bleeds, resulting in iron deficiency anaemia. Obstruction leads to dysphagia, epigastric fullness or vomiting. Weight loss can be profound. W ith pyloric involvement the presentation may be of gastric Armand Trousseau , 1801–1867, physician, Hôtel-Dieu de Paris, Paris, France. The sign led him to suspect that he personally had gastric cancer, however it proved to be pancreatic cancer on post-mortem. Pekka August Laurén , 1922–2016, pathologist, University of Turku, Finland. Robert Borrmann , 1870–1943, pathologist, Bremen, Germany . - nounced than when duodenal ulceration leads to obstruction. Non-metastatic e ff ects of malignancy are seen, particularly thrombophlebitis (Trousseau’s sign) and deep venous throm - bosis. These features result fr om the e ff ects of the tumour on thrombotic and haemostatic mechanisms.