Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive postprandial epigastric pain, early satiety, and non-bilious projectile vomiting containing undigested food particles ingested >6 hours prior. History significant for chronic peptic ulcer disease (PUD) or NSAID use. Denies hematemesis or melena. Reports significant weight loss and symptoms of dehydration.
Clinical Examination Findings
General: Patient appears cachectic and dehydrated. Abdomen: Distended with visible peristaltic waves in the epigastrium. Succussion splash elicited on physical examination. Bowel sounds: High-pitched or hyperactive initially, followed by silence. Tenderness: Mild epigastric tenderness without rebound or guarding.
Treatment Protocol
Initial management: NPO status, nasogastric tube decompression, and aggressive fluid resuscitation with electrolyte correction (hypokalemic, hypochloremic metabolic alkalosis). PPI therapy (IV). Endoscopic evaluation for balloon dilation or surgical consultation for pyloroplasty/gastrojejunostomy if refractory to medical management.