Pyloric obstruction

Obstructing disorders Pyloric obstruction Small bowel obstruction Colonic obstruction Achalasia... 

Use with caution in patients with pyloric obstruction, urinary bladder neck obstruction, and in patients suspected of having intestinal obstruction. Use with special caution in the elderly or in individuals with impaired metabolic, liver, or kidney functions because of the increased likelihood of CNS effects. 

Gl Obstructive disease (eg, achalasia, pyloroduodenal stenosis or pyloric obstruction, cardiospasm) paralytic ileus intestinal atony of the elderly or debilitated severe ulcerative colitis toxic megacolon complicating ulcerative colitis hepatic disease. 

Figure 16.8 Gamblegrams illustrating serum cation and anion distribution in patients with pyloric obstruction, severe diarrhea, and Addison s disease. (Reproduced by permission from Hoffman WS. The Biochemistry of Clinical Medicine, 4th ed. Chicago, Yearbook, 1970, p. 252.)...

Indications Qi vacuity with heat, qi counterflow and no downbearing. Hiccup, nausea and vomiting, morning sickness, post-surgical persistent hiccup, chronic gastric diseases, and incomplete pyloric obstruction... 

Hemorrhage Iron deficiency anemia Penetration into adjacent organs Perforation (X-ray shows free air under the diaphragm) Pyloric obstruction... 

These drugp are contraindicated in those with a hypersensitivity to the anticholinergic dragp, those with glaucoma (angle-closure), pyloric or duodenal obstruction, peptic ulcers, prostatic hypertrophy, achalasia (failure of... 

Pyloric or duodenal obstruction obstructive intestinal lesions or ileus achalasia Gl hemorrhage obstructive uropathies of the lower urinary tract. 

Urinary/Gastric retenf/on Administer with caution to patients with clinically significant bladder outflow obstruction because of the risk of urinary retention and to patients with Gl obstructive disorders, such as pyloric stenosis, because of the risk of gastric retention. 

Hypersensitivity to any component glaucoma, particularly angle-closure glaucoma pyloric or duodenal obstruction stenosing peptic ulcers prostatic hypertrophy or... 

Acetylcholine-blocking drugs should be avoided in patients with prostatic hyperplasia, obstructive gastrointestinal disease (eg, pyloric stenosis or paralytic ileus), or angle-closure glaucoma. In parkinsonism patients receiving antimuscarinic medication, concomitant administration of other drugs with antimuscarinic properties (eg, tricyclic antidepressants or antihistamines) may precipitate some of the complications mentioned above. 

Enteric coating reduces the rate of absorption of aspirin. In cases of severe overdosage this can cause difficulties in diagnosis and treatment, since early plasma salicylate measurements are unreliable, maximum blood concentrations sometimes not being reached until 60 or 70 hours after overdose (94,95). Another complication of the use of enteric-coated aspirin is the risk of gastric outlet obstruction and the resulting accumulation of tablets because of subclinical pyloric stenosis. 

Prolonged vomiting or nasogastric suction Pyloric or upper duodenal obstruction Prolonged or abusive diuretic therapy (loop diuretics) Villous adenoma Posthypercapnic state... 

In some cases, such as in pyloric stenosis, which involves obstruction between the stomach and the duodenum with consequent vomiting, leading to loss of hydrochloric acid and volume depletion, a diminished glomerular filtration rate leads to metabolic alkalosis. Because a low glomerular filtration rate affects the secretion of hydrogen ions, the ability to reabsorb bicarbonate is also affected. A low glomerular filtration rate also reduces the quantity of bicarbonate that is filtered. As such, the ability to correct acidosis or alkalosis is affected when glomerular filtration rate is reduced. 

D. If the victim survives, scarring from the initial corrosive injury may result in pyloric stricture or other intestinal obstructions. 

Pyloric stenosis may lead to obstruction of the lumen and usually presents beyond the neonatal period. However, it has been diagnosed in utero and can be seen in the neonatal period after administration of prostaglandin E to infants with ductus-dependent congenital heart disease. The stenosis is produced by central foveolar hyperplasia. On sonography, mucosal thickening often with polypoid or lobular appearance is observed, different from the muscular thickening observed in hypertrophic pyloric stenosis (Peled et al. 1992 Babyn et al. 1995) (Fig. 1.2). 

The blood chloride levels are reduced in some forms of alkalosis—for example, when chronic vomiting occurs—as in pyloric stenosis or other types of obstructions. 

Fig. 3.7a, b. An 8-year-old patient with recurrent signs of obstruction 4 weeks after stent placement for pyloric stenosis, a A barium study shows obstruction of the outflow at the distal end of the stent due to abutting of the stent end to the wall of the descending duodenum, b There is good flow of barium after placement of a second stent coaxially... 

The pathologic specimens of the stomach and tumor (resected in 1881 by Billroth) of Theresa Heller, on display at the Josephinum in Vienna. The left bottle is the resection specimen, containing the obstructed pyloric antrum that was successfully resected. The right specimen is of the stomach, recovered at autopsy SVi months later, when the patient died of hepatic metastases. The patent gastroduodenal anastomosis is evident. It is worthy of note that more than a century later, the survival of patients with gastric cancer has not improved appreciably since the first intervention by Billroth. 

These include ulcers in the distal duodenum, the presence of a double pyloric canal (Fig. 5.8b,c), or multiple recurrent anastomotic ulcers. Other findings include a non-dilated non-obstructed stomach filled with diluted barium due to hypersecretion, dilatation of the duodenum and proximal small bowel, sluggish gastric peristalsis, and thickening of gastric and duodenal folds (Berg and Wolfe 1991 Hirschowitz 1997). 

Primary tuberculosis of stomach and duodenum is very rare and usually develops secondary to pulmonary tuberculosis. Simultaneous involvement of the duodenum occurs in 10% of patients. There is increased incidence in patients with AIDS. The radiological appearances are classified as predominantly ulcerative or hypertrophic type (Tishler 1979 Agrawal et al. 1999). The ulcerative form is more frequent and consists of multiple large and deep ulcerations, sometimes with antral fistulas (Fig. 5.10). In the hypertrophic form, there is thickening of stomach and duodenal folds which can lead to pyloric stenosis and gastric outlet obstruction. A narrowed antrum can mimic a linitis plastica appearance. There is usually extensive lymph node involvement in the adjacent areas (Tishler 1979 Agrawal et al. 1999). Sarcoidosis and syphilis have identical appearances on conventional barium studies, both ulcerative and hypertrophic (Fig. 5.11). 

Fig. 11.7. CT of an obstructing pyloric tumour white arrow). The stomach (S) is distended and there is dilatation of the common bile duct black arrow) and some intrahepatic ducts arrowhead)...

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