Acute gastric distension
Theory
Acute gastric distension results in the stomach filling with fluid, which causes nausea and vomiting.
In patients who have an altered conscious state/undergoing general anaesthetic, gastric distension is a significant risk for aspiration.
Decompression relieves symptoms of nausea and vomiting and improves blood flow to the wall of the stomach, which aids in return of peristalsis and resolution of the distension.
Immediate intern management
Targeted history and examination and suspect diagnosis.
- Nil orally.
- Obtain IV access and commence IV fluids.
- Administer anti-emetic medication:
- Maxalon 20 mg IV
- Ondansetron 2–4 mg IV.
- Simple investigations if diagnosis unclear.
- Insert NGT
- (Place on free drainage and four-hourly aspirations).
- Contact surgical registrar and unit registrar.
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Clinical features
History
- General patient features
- Nausea
- Colicky upper abdominal pain
- Abdominal distension
- PHx
- Recent surgery
- Head injury
- Last meal
- Vomiting (late symptom)
Examination
- Hydration status
- Distended abdomen
- Succussion splash
- Abdominal tenderness
- High pitched tinkling bowel sounds
- Hernia
Risk factors/reversible causes
- SBO
- Ileus
- Medication
- Head injury
- Altered conscious state
- Metabolic derangement
- Post gastric surgery
Causes
Common
- Post meal
- Enteral feeding
- SBO
- Medications
- Ileus
- Post abdominal surgery
Rare
- Peptic ulceration
- Air swallowing
Investigations
First line
- AXR (erect and supine), erect CXR
- Dilated stomach with air fluid level
- Signs of SBO with multiple air fluid levels
- Basic blood tests
Second line
- Contrast studies
Definitive management
Identify risk factors and correct reversible factors
- NGT insertion is definitive and allows decompression of the stomach; it also reduces the risks of aspiration from acute gastric distension
Prevention
- NGT insertion for treatment of SBO
- Critical review of medication charts by parent units
- Suspicion in cases of head injury or altered conscious state
- Correct metabolic abnormalities
- Cautious resumption of oral intake post general anaesthetic and abdominal operations
- Ensure adequate period of fasting prior to general anaesthetic
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