Acute gastric dilatation

Gastroenterology

Clinicals - History

Fact Explanation
Abdominal pain Most of the time patients complain of vague abdominal pain and distension. Abdominal pain
Most of the time patients complain of vague abdominal pain and distension.
Vomiting Nausea and vomiting are seen in more than 90% of patients with acute gastric dilatation. Vomiting
Nausea and vomiting are seen in more than 90% of patients with acute gastric dilatation.
History of eating disorders Patients with eating disorders (anorexia nervosa) and psychogenic polyphagia can suffer from acute gastric dilatation. These patients have decreased gastric motility and delayed gastric emptying predisposing them to acute gastric dilatation after an episode of binge eating. Gastric volume of about 3L will distend the stomach to such an extent that causes venous insufficiency. This process finally leads to diminished perfusion and gastric perforation. History of eating disorders
Patients with eating disorders (anorexia nervosa) and psychogenic polyphagia can suffer from acute gastric dilatation. These patients have decreased gastric motility and delayed gastric emptying predisposing them to acute gastric dilatation after an episode of binge eating. Gastric volume of about 3L will distend the stomach to such an extent that causes venous insufficiency. This process finally leads to diminished perfusion and gastric perforation.
Cardiopulmonary resuscitation Cardiopulmonary resuscitation can increase the gastric pressure resulting in gastric dilatation and venous insufficiency. Cardiopulmonary resuscitation
Cardiopulmonary resuscitation can increase the gastric pressure resulting in gastric dilatation and venous insufficiency.
Symptoms of gastric perforation Patients with acute gastric dilatation may progress in to gastric rupture. This will lead you the development of peritonitis. If peritonitis is present patient will be febrile and lie still on the bed. Symptoms of gastric perforation
Patients with acute gastric dilatation may progress in to gastric rupture. This will lead you the development of peritonitis. If peritonitis is present patient will be febrile and lie still on the bed.
Collapse Patients with peritonitis and sepsis collapse due to hypotension and septic shock. The aorta can be compressed by the dilated stomach which reduces the cardiac output. This can be another cause for collapse. Collapse
Patients with peritonitis and sepsis collapse due to hypotension and septic shock. The aorta can be compressed by the dilated stomach which reduces the cardiac output. This can be another cause for collapse.
Oliguria and or anuria Intra-thoracic pressure increases in response to acute dilatation of the stomach. This will lead to reduced arterload and reduced cardiac output, resulting diminished renal perfusion. This leads to the development of oliguria and later if untreated progress to anuria. Oliguria and or anuria
Intra-thoracic pressure increases in response to acute dilatation of the stomach. This will lead to reduced arterload and reduced cardiac output, resulting diminished renal perfusion. This leads to the development of oliguria and later if untreated progress to anuria.
History of gastrointestinal diseases Gastroduodenal Crohn’s disease, gastro duodenal tuberculosis, annular pancreas, gastrointestinal tumors, volvulus of hiatal hernia and bezoars are other etiological factors for acute gastric dilatation. In addition diabetes, ingestion of caustic substances can also cause acute gastric dilatation. History of gastrointestinal diseases
Gastroduodenal Crohn’s disease, gastro duodenal tuberculosis, annular pancreas, gastrointestinal tumors, volvulus of hiatal hernia and bezoars are other etiological factors for acute gastric dilatation. In addition diabetes, ingestion of caustic substances can also cause acute gastric dilatation.
History of gastrointestinal surgery Patients can develop acute gastric dilatation as a postoperative complication of splenectomy and abdominal surgery. Disruption of blood supply to the stomach can also predispose to acute gastric dilatation. History of gastrointestinal surgery
Patients can develop acute gastric dilatation as a postoperative complication of splenectomy and abdominal surgery. Disruption of blood supply to the stomach can also predispose to acute gastric dilatation.

Clinicals - Examination

Fact Explanation
BMI Patients with anorexia nervosa are extremely thin built and have very low BMI. BMI
Patients with anorexia nervosa are extremely thin built and have very low BMI.
Febrile Patients are febrile if they develop peritonitis and or sepsis. Febrile
Patients are febrile if they develop peritonitis and or sepsis.
Abdominal examination Abdomen is distended in almost every patient with acute gastric dilatation. If peritonitis develops secondary to gastric perforation, diffuse abdominal tenderness, board like rigidity and guarding can be elicited. Abdominal examination
Abdomen is distended in almost every patient with acute gastric dilatation. If peritonitis develops secondary to gastric perforation, diffuse abdominal tenderness, board like rigidity and guarding can be elicited.
Blood pressure Patients with septic shock have low blood pressure and small volume pulse. Aortic compression can be another cause for the hypotension. Blood pressure
Patients with septic shock have low blood pressure and small volume pulse. Aortic compression can be another cause for the hypotension.
Signs of dehydration Patients develop signs of dehydration secondary to severe vomiting. Reduced skin turgor, dry mucous membranes, dry skin and sunken eyes are indicative of dehydration. Signs of dehydration
Patients develop signs of dehydration secondary to severe vomiting. Reduced skin turgor, dry mucous membranes, dry skin and sunken eyes are indicative of dehydration.

Investigations - Diagnosis

Fact Explanation
X-ray Abdominal X-ray will reveal a massively dilated stomach. In the presence of gastric perforation pneumo-peritoneum can be detected by erect chest X-ray. X-ray
Abdominal X-ray will reveal a massively dilated stomach. In the presence of gastric perforation pneumo-peritoneum can be detected by erect chest X-ray.
CT scan CT scan of the stomach is helpful in detecting massively dilated stomach. CT scan is considered superior to the X-ray in making the diagnosis. CT scan
CT scan of the stomach is helpful in detecting massively dilated stomach. CT scan is considered superior to the X-ray in making the diagnosis.
Upper gastrointestinal endoscopy (UGIE) UGIE is helpful in stable patients. Ischemic changes can be observed mainly over the greater curvature of the stomach sparing the lesser curvature and the pyloric regions. Upper gastrointestinal endoscopy (UGIE)
UGIE is helpful in stable patients. Ischemic changes can be observed mainly over the greater curvature of the stomach sparing the lesser curvature and the pyloric regions.
Measurement of intra-abdominal pressure Measurement of intraabdominal pressure, especially if acute gastric dilatation is anticipated (eg: after abdominal surgery) will help for the early detection of acute gastric dilatation. Measurement of intra-abdominal pressure
Measurement of intraabdominal pressure, especially if acute gastric dilatation is anticipated (eg: after abdominal surgery) will help for the early detection of acute gastric dilatation.

Investigations - Management

Fact Explanation
Serum electrolytes Patients with eating disorders especially anorexia nervosa can have low serum potassium levels which should be corrected prior to surgery. Serum electrolytes
Patients with eating disorders especially anorexia nervosa can have low serum potassium levels which should be corrected prior to surgery.
Full blood count Sepsis is a possible complication of perforation of the stomach and peritonitis. Full blood count
Sepsis is a possible complication of perforation of the stomach and peritonitis.

Management - Supportive

Fact Explanation
Fluid management Patients can be dehydrated because of severe vomiting. Intravenous fluid replacement is essential in the patient management. Fluid management
Patients can be dehydrated because of severe vomiting. Intravenous fluid replacement is essential in the patient management.

Management - Specific

Fact Explanation
Staged decompression of the stomach Decompression of the stomach is first attempted via a nasogastric tube. If the aorta is being compressed by the dilated stomach sudden decompression of the stomach can lead to quick restoration of the systemic perfusion. This leads to sudden release of lactic acid which was a byproduct of anaerobic metabolism. This adverse squeal is prevented by staged decompression of the stomach.
Even after successful decompression of the stomach perforation and hemorrhage can occur. So patient should be kept monitoring.
Staged decompression of the stomach
Decompression of the stomach is first attempted via a nasogastric tube. If the aorta is being compressed by the dilated stomach sudden decompression of the stomach can lead to quick restoration of the systemic perfusion. This leads to sudden release of lactic acid which was a byproduct of anaerobic metabolism. This adverse squeal is prevented by staged decompression of the stomach.
Even after successful decompression of the stomach perforation and hemorrhage can occur. So patient should be kept monitoring.
Surgery Early diagnosis and treatment is crucial in preventing ischemic necrosis and perforation of the stomach. Surgical exploration (diagnostic laparotomy) is mandatory in unstable patients, because gastric perforation should always be kept in mind. In the presence of ischemic necrosis, surgical resection of the gangrenous segment should be done. If the total stomach is gangrenous total gastrectomy is done. If the patient is stable esophagojejunostomy can be done for reconstruction, however if the patient is unstable esophagostomy is done. Surgery
Early diagnosis and treatment is crucial in preventing ischemic necrosis and perforation of the stomach. Surgical exploration (diagnostic laparotomy) is mandatory in unstable patients, because gastric perforation should always be kept in mind. In the presence of ischemic necrosis, surgical resection of the gangrenous segment should be done. If the total stomach is gangrenous total gastrectomy is done. If the patient is stable esophagojejunostomy can be done for reconstruction, however if the patient is unstable esophagostomy is done.

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