m Aetiology:
1- Spasm due to irritation ® reversible
2- Fibrosis, later on ® irreversible
m Cl. Picture:
1- Long history of peptic ulcer.
2- Vomiting which is; projectile, not bile stained and containing old food particles.
3- Constipation.
4- Dehydration with alkalosis and electrolyte imbalance.
5- Succusion splash.
6- Visible peristalsis from Lt to Rt.

m Investigations:
1- Barium meal: may shows:
a) Delayed evacuation
b) Huge dilatation of stomach which may reach the pelvis (J shaped stomach).
c) Barium may settle down at the dilated stomach ® soup plate appearance
2- Gastroscope:
a- Fails to pass into the duodenum. b- To exclude malignancy.
3- Gastric acidity tests:
a) False achlorohydria due to mucus content.
b) If true achlorohydria (persist after histamine injection), malignancy should be suspected.
c) False hyperacidity may occur due to fermentation of stagnant food, So, stomach should be washed thouroughly before the test is done.
m Diff. diagnosis: see below.
m Treatment: Usually surgical
1- Vagotomy and gastrojejunostomy.
2- Gastrojejunostomy alone in old pnt with bad condition.
SOURCE: DR. AYMAN SALEM'S BOOK
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