WordNet

the physical condition of blocking or filling a passage with an obstruction (同)blockage
any structure that makes progress difficult (同)obstructor, obstructer, impediment, impedimenta
getting in someones way
the act of obstructing; "obstruction of justice"
relating to or involving the stomach; "gastric ulcer" (同)stomachic, stomachal

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〈U〉(…への)妨害,障害《+『to』+『名』》 / 〈C〉(…への)妨害物,障害物《+『to』+『名』》
(水・煙などの)『出口』,はけ口《+『for』+『名』》 / (感情・精力などの)『はけ口』《+『for』+『名』》 / 《米》(電気コードの)差し込口 / (特定の商品の)販売口,販路《+『for』+『名』》
胃の,胃に発生する

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/02/06 16:15:05」(JST)

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Gastric outlet obstruction (often abbreviated as GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with gastric outlet obstruction will often have recurrent vomiting of food that has accumulated in the stomach, but which cannot pass into the small intestine due to the obstruction. The stomach often dilates to accommodate food intake and secretions. Causes of gastric outlet obstruction include both benign causes (such as peptic ulcer disease affecting the area around the pylorus), as well as malignant causes, such as gastric cancer.

Causation related to ulcers may involve severe pain which the patient may interpret as a heart condition/attack.^[1]

Treatment of the condition depends upon the underlying cause; it can involve antibiotic treatment when H. Pylori is related to an ulcer,^[2] endoscopic therapies (such as dilation of the obstruction with balloons or the placement of self expandable metallic stents), other medical therapies, or surgery to resolve the obstruction.

Causes

The causes are divided into benign or malignant.

Benign
- Peptic ulcer disease
- Infections, such as tuberculosis; and infiltrative diseases, such as amyloidosis.
- A rare cause of gastric outlet obstruction is blockage with a gallstone, also termed Bouveret's syndrome.
- In children congenital pyloric stenosis / congenital hypertrophic pyloric stenosis may be a cause.
- A pancreatic pseudocyst can cause gastric compression.
- Pyloric mucosal diaphragm could be a rare cause.
Malignant
- Tumours of the stomach, including adenocarcinoma (and its linitis plastica variant), lymphoma, and gastrointestinal stromal tumours

Pathophysiology

In a peptic ulcer it is believed to be a result of edema and scarring of the ulcer, followed by healing and fibrosis, which leads to obstruction of the gastroduodenal junction (usually an ulcer in the first part of the duodenum).^[3]

Clinical features

The main symptom is vomiting, which typically occurs after meals of undigested food, devoid of any bile. A history of previous peptic ulcers and loss of weight is not uncommon. In advanced cases, signs to look for on physical examination are wasting and dehydration. Visible Peristalsis from left to right may be present. Succussion splash is a splash-like sound heard over the stomach in the left upper quadrant of the abdomen on shaking the patient, with or without the stethoscope. Bowel sound may be increased due to excessive peristaltic action of stomach. Fullness in left hypochondrium may also be present.

Management

Investigations

The most confirmatory investigation is endoscopy of upper gastrointestinal tract.

Laboratory

Individuals with gastric outlet obstruction are often hypochloremic, hypokalemic, and alkalotic due to loss of hydrogen chloride and potassium. High urea and creatinine levels may also be observed if the patient is dehydrated.

Abdominal X-ray

A gastric fluid level may be seen which would support the diagnosis.

CALcification

Barium meal and follow through

May show an enlarged stomach and pyloroduodenal stenosis.^[4]

Gastroscopy

May help with cause and can be used therapeutically.

Treatment

Treatment of gastric outlet obstruction depends on the cause, but is usually either surgical or medical.

Medical In most patients with peptic ulcer disease, the oedema will usually settle with conservative management with nasogastric suction, replacement of fluids and electrolytes and proton pump inhibitors.

Surgical Surgery is indicated in cases of gastric outlet obstruction in which there is significant obstruction and in cases where medical therapy has failed.^{[citation needed]} Endoscopic balloon therapy may be attempted as an alternative to surgery, with balloon dilation reporting success rates of 76% after repeat dilatons.^[5] The operation usually performed is an antrectomy, the removal of the antral portion of the stomach. Other surgical approaches include: vagotomy, the severing of the vagus nerve, the Billroth I, a procedure which involves anastomosing the duodenum to the distal stomach, or a bilateral truncal vagotomy with gastrojejunostomy.

Differential Diagnosis

The differential diagnosis of gastric outlet obstruction may include: early gastric carcinoma hiatal hernia, gastroesophageal reflux, adrenal insufficiency, and inborn errors of metabolism.^{[citation needed]}

References

^ http://www.webmd.com/digestive-disorders/digestive-diseases-peptic-ulcer-disease
^ http://www.webmd.com/digestive-disorders/digestive-diseases-peptic-ulcer-disease
^ Doherty GM, Way LW, editors. Current Surgical Diagnosis & Treatment. 12th Edition. New York: Mcgraw-Hill; 2006.
^ Mieny CJ. General Surgery.6th Ed. Pretoria: Van Schaik; 2006.
^ Lam YH, Lau JY, Fung TM, et al. Endoscopic balloon dilation for benign gastric outlet obstruction with or without Helicobacter pylori infection. Gastrointest Endosc. Aug 2004;60(2):229-33

Gastric outlet obstruction due to duodenal tuberculosis

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人における胃流出路閉塞 gastric outlet obstruction in adults
2. 成人における胃捻転 gastric volvulus in adults
3. 悪性疾患による胃十二指腸閉塞緩和のための経腸ステント enteral stents for the palliation of malignant gastroduodenal obstruction
4. 消化性潰瘍の合併症の概要 overview of the complications of peptic ulcer disease
5. Surgical resection of lesions of the head of the pancreas

English Journal

Acute gastric outlet obstruction after left hemicolectomy.

Chen YY, Ke TW, Chen WT.SourceDivision of Gastroenterology, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Gastroenterology.Gastroenterology.2012 Nov;143(5):e12-3. doi: 10.1053/j.gastro.2012.04.002. Epub 2012 Sep 23.
PMID 23010300

Cost-effectiveness of laparoscopic versus open pyloromyotomy.

Carrington EV, Hall NJ, Pacilli M, Drake DP, Curry JI, Kiely EM, De Coppi P, Pierro A, Eaton S.SourceUCL Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.
The Journal of surgical research.J Surg Res.2012 Nov;178(1):315-20. doi: 10.1016/j.jss.2012.01.031. Epub 2012 Mar 27.
BACKGROUND: Infantile hypertrophic pyloric stenosis can be corrected by either open (OP) or laparoscopic pyloromyotomy (LP). LP may provide clinical benefits of reduced time to postoperative full feeds and reduced postoperative inpatient stay, but the cost effectiveness is not known. Our aim was to
PMID 22480835

Japanese Journal

症例間欠的に胃幽門の閉塞を生じた胃過形成性ポリープの1例

坂田泰志,内藤優香,中元寺美咲 [他]
内科 111(1), 179-181, 2013-01-00
NAID 40019541970

当院で経験した胃瘻チューブの位置異常による幽門閉塞3症例の検討

明石哲郎,高橋俊介,淀江賢太郎,山田真梨子,吉村大輔,落合利彰,土田治,壁村哲平
日本消化器病學會雜誌 = The Japanese journal of gastro-enterology 109(4), 600-605, 2012-04-05
経皮内視鏡的胃瘻造設術（PEG）の後期合併症としては比較的まれな胃瘻チューブのバルーンによる幽門閉塞症例を3例経験した．全例嘔吐で出現しており，2例は逆流性食道炎による吐血をともなった．胃潰瘍を1例，嚥下性肺炎を2例，膵炎を1例に認めた．治療はバルーンの位置の修正で容易に軽快しており，胃瘻管理中の患者の嘔吐の病態にはチューブの位置異常も考慮するとともに，普段の胃瘻管理が重要であると考えられた．
NAID 10030560595

Related Pictures

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★リンクテーブル★

リンク元	「幽門閉塞」「胃流出路閉塞」
関連記事	「obstruction」「gastric」

「幽門閉塞」

Gastric outlet obstruction
	Decubitus x-ray of abdomen of patient with gastric outlet obstruction. There is a prominent gastric air bubble, gastric air-fluid level, and a dilated stomach with particulate matter within it.
Classification and external resources
ICD-10	K31.1
ICD-9	537.0
eMedicine	article/190621