Gastroparesis with Case

00:01 Let's begin a new case.

00:02 So we have a 65-year-old man seen in clinic for a 2-week history of frequent nausea and vomiting.

00:09 He vomits about 30 minutes after eating meals and notes frequent stomach gurgling and bloating between meals He has a history of uncontrolled type 2 diabetes and had a cholecystectomy 10 years ago.

00:21 He lost 2 kg in the last month but denies dysphagia, odynophagia or abdominal pain.

00:29 His vitals are normal, and on exam when auscultating the stomach, he has an audible splashing sound when he is rocked side to side.

00:37 What is the most likely diagnosis? So some key features of this case include: his dyspepsia with vomiting immediately after meals, and he has a history of uncontrolled diabetes plus a history of abdominal surgery.

00:54 In addition on exam, he has what's called a "succussion splash" which is when you hear audible food splashing around when the patient is rocked side to side.

01:04 This indicates the presence of gas and food in the stomach.

01:10 So how do we know that this patient does not have a small bowel obstruction? In any patient, coming in with nausea and vomiting, you should always make sure that you have ruled out a small bowel obstruction.

01:21 So you must ask about abdominal pain, constipation, obstipation, and any history of abdominal surgeries.

01:30 So let's talk a bit about this condition, gastroparesis.

01:33 Gastroparesis is when you have slow or delayed clearance of gastric contents.

01:39 In general, patients come in with a feeling of being full very soon after eating, so early satiety and postprandial fullness.

01:47 They may have nausea and vomiting, abdominal pain and bloating, and weight loss.

01:55 Gastroparesis is a condition that's easily confused for many other diagnoses such as the ones listed here.

02:01 Because of this, endoscopy must be done to rule out any malignant obstructions such as the mechanical obstruction and you may also do a test called a 'gastric emptying test' to confirm this diagnosis.

02:16 In general, the treatment consist of treating the patient's dehydration or any electrolyte disturbances that result from their gastroparesis.

02:25 You may also do dietary modification, such as encouraging the patient to eat small, frequent meals, avoiding meals high in fiber which can make their symptoms worse, and providing anti-emetics for symptom control.

02:38 So we spoke earlier about a gastric emptying study.

02:42 A gastric emptying study is done by giving the patient barium contrast to swallow and then taking abdominal x-rays at various time points after ingesting contrast In this example, on the left side, you can see the stomach highlighted with contrast immediately after the patient drank barium contrast.

03:00 20 hours later, on the right side, you now see that there is contrast in the stomach and some of it has passed on to the bowel.

03:08 In normal study, what have shown, all of the contrast leave the stomach by this point since it's been 20 hours however in this case ,there is still contrast in the stomach which indicates a positive test for gastroparesis.

03:22 So why does gastroparesis occur? You should always make sure to look for an underlying etiology Frequent causes include diabetes, thyroid disease, neurologic disease, prior history of gastric surgery, any autoimmune disorders and post-viral syndromes.

03:40 So now let's go back to our case.

03:42 We had a 65-year-old man with dyspepsia, vomiting immediately after meals, a history of uncontrolled diabetes and abdominal surgery with a succussion splash on exam, which is abnormal.

03:54 So his uncontrolled diabetes places him at high risk for gastroparesis, and his history of abdominal surgery places him at risk for an SBO.

04:03 In this case, the most likely diagnosis is gastroparesis due to his underlying diabetes.

04:09 Thank you very much for your attention.