VISIBLE PERISTALSIS

This is almost invariably a sign of gastric outlet or intestinal obstruction. The various causes can be recalled using the mnemonic MINT. M—Malformation should bring to mind congenital pyloric stenosis, malrotation, hernias, and volvulus. I—Inflammation should alert one to peptic ulcer causing gastric outlet obstruction or Crohn disease, ulcerative colitis, and diverticulitis causing internal obstruction. N—Neoplasm should help recall gastric outlet obstruction caused by a leiomyoma or gastric carcinoma, intestinal obstruction caused by neoplasms of the large and small intestine, and pancreatic carcinoma. T—Trauma would help to recall intestinal obstruction caused by adhesions from previous abdominal surgery.

Approach to the Diagnosis

Congenital pyloric stenosis presents with projectile vomiting, dehydration, and a small right upper quadrant mass. The peristaltic waves are in the upper abdomen progressing downward from right to left. The peristalsis of small intestinal obstruction is also transverse, whereas the peristalsis of large intestinal obstruction is often vertical. The diagnostic workup includes a stat CBC, electrolytes, chemistry panel, and flat plate of the abdomen. A general surgeon must see the patient immediately as an exploratory laparotomy is usually indicated.

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Visible peristalsis: Introduction (review 6 causes)
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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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