Pyloric Stenosis

 Pyloric Stenosis

Pyloric Stenosis is congenital disease in infants between 2-8 weeks of age.

Narrowing and obstruction of the lower portion of stomach (phylorus) that prevents food from moving from stomach to intestine.

Caused due to hypertrophy and hyperplasia of circular muscles of stomach.

It is obstruction in lumen of the pylorus due to increase in size of the musculature (hypertrophy of the circular muscular pyloric sphincter.

Etiology

1. Genetic factor

2. Premature birth

 Pathophysiology

Hypertrophy and hyperplasia of smooth muscle.

Elongation and thickening of pylorus

Narrowing of lumen of pylorus, result in partial or complete obstruction.

Pyloric Stenosis

Attempt to push food forward through obstruction, vigorous peristalsis occurs.

Persistent vomiting and dilated stomach musculature.

Infant develop dehydration

Clinical Manifestation

Appears (2-4 weeks of age)

1. Projectile vomiting

2. Abdominal distension

3. Weight loss

4. Dehydration

5. Failure to thrive

6. Constipation

7. Fewer bowl movement

8. Regurgitation; during and after feeding

9. Reduce frequency and amount of stool

Diagnostic Evaluation

1. Prenatal history

2. X ray

3. Endoscopy

4. Ultrasonography

5. Serum electrolyte (low sodium and potassium)

6. Physical examination

Olive size mass in epigastrium to right of midline.

7. Barium study of upper gastrointestinal tract.

Barium meal X ray; reveals delayed emptying of gastric content, narrowing of pylorus.

8. Blood investigation

Decrease serum sodium, potassium, chloride level with increase serum bicarbonate and PH.

Due to prolonged vomiting resulting in metabolic alkalosis.

9. Due to dehydration

Urine concentrated with specific gravity >1.030

Management

1. Pyloromyotomy (fredet ramstedt surgery)

Longitudinal incision through anterior wall of pyloric canal to the level of submucosa.

Opens up tight circular muscle of pylorus that had caused narrowing; allowing passage of food from stomach to intestine.

(Open or laparoscopic surgery)

Observe Signs of Complication

1. Observe incision for signs of inflammation and drainage

2. Operative dressing kept clean

3. Vital sign records

4. Sign of abdominal distension recorded

5. Diper applied low and change frequently

Parental Education

1. Explained about technique, type of food and position after feeding.

2. Keep dressing clean

3. Check incision site for sign of Infection