 61 y o female with recent onset of nausea and vomiting  Roux-en-y gastric bypass 2 months ago due to an iatrogenic gastric perforation  History of gastric antral vascular ectasia (GAVE) syndrome

Angioectatic stripes Flat mucosal vascular anomalies Cause slow blood loss Usually responsive to ablative therapy

Jejunum Duodenum

1.No esophageal stricture or dilatation 2.Mild esophageal dysmotility 3.Narrowing at the gastro-jejunal (GJ) junction 4.Delayed emptying of the gastric pouch

 Motility disorder in the Roux limb due to the rearrangement of the small bowel  Symptoms:  Postprandial abdominal pain  Nausea  Bloating  Treatment:  Hydration  Medications: Antiemetics and prokinetic agents