Difference between revisions of "Acute gastric dilation"
(→Differential Diagnosis) |
(→Etiologies) |
||
| Line 6: | Line 6: | ||
==Etiologies== | ==Etiologies== | ||
*Occurs after binge eating episodes, typically in those with an eating disorder | *Occurs after binge eating episodes, typically in those with an eating disorder | ||
| − | * | + | **[[Anorexia nervosa]] |
| − | * | + | **[[Bulimia nervosa]] |
| + | **Also Psychogenic [[polyphagia]] | ||
| + | *Mechanical obstruction | ||
| + | **[[Pyloric stenosis]] | ||
| + | **Stricture/adhesions | ||
| + | **[[SMA syndrome]] | ||
| + | **Gastric [[volvulus]] | ||
| + | *Other etiologies including [[Diabetes mellitus]], trauma, spinal conditions | ||
==Pathogenesis== | ==Pathogenesis== | ||
Revision as of 02:10, 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
- Anorexia nervosa
- Bulimia nervosa
- Also Psychogenic polyphagia
- Mechanical obstruction
- Pyloric stenosis
- Stricture/adhesions
- SMA syndrome
- Gastric volvulus
- Other etiologies including Diabetes mellitus, trauma, 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