Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • History of symptomatic peptic ulcer disease• Anorexia, vomiting, and failure to gain relief from antacids• Vomitus contains undigested food +++ Epidemiology + • Duodenal ulcer is a more common cause of obstruction than gastric ulcer• Gastric ulcers that cause obstruction are close to the pylorus• Obstruction is less common than either bleeding or perforation +++ Symptoms and Signs + • History of symptomatic peptic ulcer disease• Increasing ulcer pain with anorexia, vomiting of undigested food, and failure to gain relief from antacids• Absence of bile pigment in vomitus reflects level of duodenal obstruction• Weight loss, dehydration, and malnutrition may be marked• Peristalsis of the distended stomach may be visible• Upper abdominal distention and tenderness are usually apparent• Tetany with advanced alkalosis +++ Laboratory Findings + • Serum studies show hypochloremia, hypokalemia, hyponatremia, and increased HCO3• Anemia in about 25% of patients• Prolonged vomiting leads to metabolic alkalosis with dehydration, which may lead to prerenal azotemia• Large amounts of sodium and HCO3- are excreted in the urine• Test for infection with Helicobacter pylori +++ Imaging Findings + • Abdominal x-rays: May show a large gastric fluid level• Contrast radiographic upper GI series: Shows retention of contrast proximal to the obstruction, with luminal narrowing at the level of the obstruction• Gastroscopy: Demonstrates luminal narrowing and is indicated to rule out an obstructing neoplasm + • Consider obstruction in any patient with a history of peptic ulcer disease and prolonged vomiting, abdominal distention, and pain +++ Rule Out + • Obstruction due to peptic ulcer must be differentiated from that caused by a malignant tumor of the antrum, the duodenum, or the pancreas + • Contrast radiographic upper GI series to confirm the diagnosis• Upper GI endoscopy to rule out malignancy as the cause of obstruction• CBC and serum electrolytes• Evaluation for H pylori infection +++ When to Admit + • High-grade obstruction with ongoing vomiting, inability to tolerate oral intake, severe dehydration, or derangement of serum electrolytes + • Replacement of fluid and electrolytes• NG tube for decompression +++ Surgery + • If conservative management fails, truncal or parietal cell vagotomy and drainage procedure is indicated +++ Indications + • Failure of the obstruction to resolve completely within 5-7 days• Recurrent obstruction of any degree +++ Contraindications + • Inadequate trial of conservative treatment +++ Medications + • H2 blockers, proton pump inhibitors• Treatment of H pylori infection• Total parenteral nutrition if patient is malnourished +++ Treatment Monitoring + • Saline load test: 700 ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.