Difference between revisions of "Acute gastric dilation"
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
| + | ===By organ system=== | ||
| + | *GI | ||
| + | **[[Peptic ulcer disease]] | ||
| + | **[[Gastritis]] | ||
| + | ***Strangulated hernia | ||
| + | **[[Pancreatitis]] | ||
| + | **[[Appendicitis]] | ||
| + | **[[Cholecystitis]], [[Cholangitis]] | ||
| + | **[[Acute Hepatitis]] | ||
| + | **[[IBD]] | ||
| + | **[[Intussusception]] | ||
| + | **Malignancy | ||
| + | **[[Mesenteric ischemia]] | ||
| + | **Esophageal disorders (e.g. achalasia, GERD, [[esophagitis]]) | ||
| + | **Functional disorders such as [[Irritable Bowel Syndrome]] | ||
| + | *Neurologic | ||
| + | **[[Cannabinoid hyperemesis syndrome]] | ||
| + | *Infectious | ||
| + | **[[Spontaneous bacterial peritonitis]] | ||
| + | **[[Urinary tract infection]] | ||
| + | **Bacterial toxins, Viruses (adeno, norwalk, rota) | ||
| + | *Drugs/Toxins | ||
| + | **Heavy metal poisoning | ||
| + | **Methanol poisoning | ||
| + | *Endocrine | ||
| + | **[[Diabetic ketoacidosis]] | ||
| + | **Thyroid/parathyroid disorders | ||
| + | **[[Uremia]] | ||
| + | *Miscellaneous | ||
| + | **[[Anorexia nervosa]], [[Bulimia nervosa]] | ||
==Evaluation== | ==Evaluation== | ||
Revision as of 02:06, 8 January 2017
Contents
Background
- Rare event
- Invariable leads to necrosis with or without perforation
- Most commonly a post-operative complication
Etiologies
- Occurs after binge eating episodes, typically in those with an eating disorder
- Psychogenic polyphagia
- Other etiologies including Diabetes mellitus, trauma, Gastric volvulus, gastric outlet obstruction Pyloric stenosis, SMA syndrome, spinal conditions
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
- GI
- Peptic ulcer disease
- Gastritis
- Strangulated hernia
- Pancreatitis
- Appendicitis
- Cholecystitis, Cholangitis
- Acute Hepatitis
- IBD
- Intussusception
- Malignancy
- Mesenteric ischemia
- Esophageal disorders (e.g. achalasia, GERD, esophagitis)
- Functional disorders such as Irritable Bowel Syndrome
- Neurologic
- Infectious
- Spontaneous bacterial peritonitis
- Urinary tract infection
- Bacterial toxins, Viruses (adeno, norwalk, rota)
- Drugs/Toxins
- Heavy metal poisoning
- Methanol poisoning
- Endocrine
- Diabetic ketoacidosis
- Thyroid/parathyroid disorders
- Uremia
- Miscellaneous
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