Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive postprandial emesis, early satiety, and significant unintentional weight loss. Emesis consists of undigested food particles consumed several hours prior. Denies hematemesis or melena. Reports epigastric fullness and discomfort. Symptoms are consistent with mechanical gastric outlet obstruction secondary to known/suspected antral malignancy.
Clinical Examination Findings
General: Cachectic appearance, signs of dehydration. Abdomen: Distended, visible peristaltic waves in the epigastrium. Succussion splash present on physical examination. Tenderness to deep palpation in the epigastric region; no rebound or guarding. Bowel sounds: High-pitched/tinkling. Rectal exam: Negative for occult blood.
Treatment Protocol
Immediate management: NPO status, nasogastric tube decompression, and aggressive IV fluid resuscitation with electrolyte correction. Consult Surgical Oncology/Gastroenterology for endoscopic stenting or surgical bypass (gastrojejunostomy) based on nutritional status and performance score. Consider nutritional support (TPN/Enteral) if severe malnutrition is present.