Difference between revisions of "Acute gastric dilation"

(Disposition)
(Differential Diagnosis)
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==Differential Diagnosis==
 
==Differential Diagnosis==
 +
===By organ system===
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*GI
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**[[Peptic ulcer disease]]
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**[[Gastritis]]
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***Strangulated hernia
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**[[Pancreatitis]]
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**[[Appendicitis]]
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**[[Cholecystitis]], [[Cholangitis]]
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**[[Acute Hepatitis]]
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**[[IBD]]
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**[[Intussusception]]
 +
**Malignancy
 +
**[[Mesenteric ischemia]]
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**Esophageal disorders (e.g. achalasia, GERD, [[esophagitis]])
 +
**Functional disorders such as [[Irritable Bowel Syndrome]]
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*Neurologic
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**[[Cannabinoid hyperemesis syndrome]]
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*Infectious
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**[[Spontaneous bacterial peritonitis]]
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**[[Urinary tract infection]]
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**Bacterial toxins, Viruses (adeno, norwalk, rota)
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*Drugs/Toxins
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**Heavy metal poisoning
 +
**Methanol poisoning
 +
*Endocrine
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**[[Diabetic ketoacidosis]]
 +
**Thyroid/parathyroid disorders
 +
**[[Uremia]]
 +
*Miscellaneous
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**[[Anorexia nervosa]], [[Bulimia nervosa]]
  
 
==Evaluation==
 
==Evaluation==

Revision as of 02:06, 8 January 2017

Background

  • Rare event
  • Invariable leads to necrosis with or without perforation
  • Most commonly a post-operative complication

Etiologies

Pathogenesis

  • Intragastric pressure >20mmHg leads to impaired intramural blood flow and mucosal necrosis
  • Gastric volumes greater than 4 liters lead to regular mucosal tears
  • Patients with pathologic eating disorders can have larger gastric volumes at baseline
  • Acute massive gastric dilation is an extreme form (intragastric pressure >30)

Clinical Features

  • Emesis is typical symptom in 90% of cases
  • Inability to vomit seen in massive distention
  • Other features include:
    • Abdominal distention
    • Abdominal pain
    • Signs of peritonitis after perforation

Differential Diagnosis

By organ system

Evaluation

  • Typical work up for abdominal pain
  • Upright chest x-ray and abdominal series to assess for free air
    • Can identify large distended stomach on x-ray
  • CT imaging if safe and indicated

Management

  • Nasogastric or orogastric decompression is first line therapy
    • Typically a large special tube required which is placed under anesthesiologist supervision in OR
  • Resuscitation with fluids and intravenous antibiotics as indicated
  • If conservative measures fail or gastric infarction suspected, surgical intervention mandatory
  • If gastric necrosis or perforation not recognized and treatment delayed, mortality reaches 80%

Disposition

  • Patient may require emergent surgical decompression
  • If improvement with non-operative decompression, may require admission for continued monitoring

See Also

External Links

References