Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Gastric outlet Obstruction Clinical Examination Discussion and Treatment
Mr.Durai, 48 yrs male from Coimbatore, who is
an electrician by occupation and belongs to
Lower socioeconomic class presented with
chief complaints of
Vomiting ? for 3 months
Mass in the upper abdomen ? for 3
months
The patient was apparently normal before 3
months after which he developed vomiting for 3
months
insidious in onset, non bilious, not blood
stained ,contains food particles
1-3 episodes per day
Immediately after food intake (within 20
minutes)
Not relieved by medication
Not projectile, non progressive
The patient also noticed a mass in the upper abdomen
Insidious in onset
Gradually progressive in nature
Associated with pain on pressing
H/O constipation, no h/o obstipation
H/O dyspepsia , no h/o belching
No h/o halitosis
H/O ball rolling movements present
H/O loss of weight (7kg in 3 months) and loss of
appetite
No h/o dysphagia
No h/o Black tarry stools
No h/o black tarry stools
No h/o fever
No h/o yellowish discolouration of sclera /
abdominal distention
No h/o bone pain
No h/o cough with haemoptysis
No h/o swelling elsewhere in the body
No h/o similar complaints in the past
No h/o previous surgeries
No h/o chronic drug intake
No h/o DM, HT ,Tuberculosis, Asthma,
Epilepsy
Consumes non vegetarian diet
Chronic alcoholic for past 20 years ? 180 ml/
day
Occasional smoker
No h/o spicy food intake
Normal bladder habits. Constipation is present
Family History
No significant family history
48 years old male, who is a chronic alcoholic
came with complaints of non-bilious vomiting-
immediately following food and water intake,
mass in the epigastrium for 3 months with
history of constipation, ball rolling movements
and loss of weight and loss of apetite. Probable
pathology is in the gastric region.
Patient is conscious, oriented , moderately built and moderately
nourished.
Pallor present, No cyanosis, No jaundice
Grade 2 clubbing present
No pedal edema
No generalized lymphadenopathy
VITAL SIGNS
Pulse Rate 75/ min, regular in rate, rhythm.No specific
character. No vessel wall thickening. No
radioradial/radiofemoral delay.
BP: 116/80 mmHg, measured in the right upper arm seated
posture
RR 15/min
Temp afebrile
After getting consent from the patient, he was
exposed from the level of the nipples to midthigh
and examined under bright light in supine
position.
INSPECTION
A single, locally distended mass is present in
the epigastric region. Size: 7x5 cm , irregular in
shape , extending 2cm below the xiphoid
process,2cm from the left costal margin, 6 cm
from the right costal margin and 5cm above the
umbilicus. Moves with respiration
Skin over the mass ? normal
On lifting the head with arms folded on chest,
mass becomes less prominent
Visible Gastric Peristalsis
Umbilicus in midline, flanks free
All quadrants move equally with respiration
No fullness in the left supraclavicular fossa
External genitalia normal
The patient's hips and knees are flexed on both
sides and examination is done.
Inspectory findings of size, shape , extent
confirmed.
Surface irregular, Ill defined margins
Moves with respiration
Left Supraclavicular node and axillary nodes
not palpable
Liver not palpable
Percussion:
Shifting dullness is absent
Liver dullness Right 5th Intercostal Space in the
Mid Clavicular line
Impaired resonance over the mass.
Resonant over other regions of the abdomen
Auscultation:
Normal Bowel sounds heard.
Per Rectal Examination
Gastric Carcinoma with Gastric Outlet
Obstruction
Differential Diagnosis:
Peptic Ulcer with ciccatrization
Baseline:
CBC- TC, DC, ESR, Hb%
Blood- Sugar, Urea
Serum Creatinine, Electrolytes
Urine ? Albumin, Sugar
Blood grouping and typing
X-Ray Chest
ECG
Specific:
Upper GI Endoscopy
Barium Meal
X-ray Abdomen
USG Abdomen
CT Abdomen
Endoscopic Ultrasonogram
Diagnostic Laparoscopy
Subtotal radical gastrectomy with anterior
gastrojejunostomy.
This post was last modified on 08 August 2021