Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with severe, chronic symptoms of gastroparesis, including intractable nausea, recurrent postprandial vomiting, early satiety, and significant epigastric bloating. Symptoms are refractory to conservative dietary management. Patient reports poor glycemic control with frequent hypoglycemic/hyperglycemic excursions. Significant weight loss noted over the past [X] months. No evidence of mechanical gastric outlet obstruction on recent imaging.
Clinical Examination Findings
General: Patient appears chronically ill, cachectic, and dehydrated. Vitals: Tachycardia noted; orthostatic hypotension present. Abdomen: Soft, non-tender, but with visible epigastric distension. Succussion splash positive 3+ hours post-prandial. Bowel sounds hypoactive. Skin: Signs of peripheral neuropathy and poor skin turgor consistent with chronic dehydration.
Treatment Protocol
1. Glycemic optimization: Insulin regimen adjustment to minimize postprandial glucose variability. 2. Prokinetic therapy: Initiation of Metoclopramide [X] mg TID AC or Erythromycin [X] mg TID AC. 3. Nutritional support: Small, frequent, low-fat, low-fiber meals; transition to liquid-based nutrition if solid food intolerance persists. 4. Hydration: IV fluid resuscitation as needed for electrolyte correction. 5. Referral: Consider gastric electrical stimulator or G-tube placement if refractory.