A 59 year old man, acutely unwell presents with vomiting and abdominal pain

Compensated hyponatraemic, hypokalaemic, hypochloraemic metabolic alkalosis without evidence of renal failure or hypoglycaemia consistent with significant vomiting. Likely to indicate vomiting over a prolonged period of time.

He has been vomiting gastric contents as evidenced from the blood gas and epigastric pain – likely to have a gastric outlet/ duodenal obstruction.

Does this man have a succusion splash – sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation. It reflects the presence of gas and fluid in an obstructed organ, as in gastric outlet obstruction.

Elicit this sign by placing your stethoscope over the epigastrium and rocking the patients hips from side to side while listening for the sloshing of fluid

The most likely cause in this relatively young patient with weight loss and backache is a malignant lesion in the stomach, duodenum or pancreas. In the elderly, gastric outlet obstruction is often caused by chronic peptic ulcer disease with scarring and secondary obstruction.

This patient had gastric outlet obstruction from lesions in his pancreas.