Congenital Hypertrophic Pyloric Stenosis

Congenital Hypertrophic Pyloric Stenosis in neonates

1. Congenital hypertrophic pyloric stenosis  DR NINAD PATIL

2. CONGENITAL HYPERTROPHIC PYLORIC STENOSIS – L eading to a narrowing of the opening between the stomach and the small intestine

3. Incidence – 1 in 500-100 live births Gender – 1 st born male >> female Age of presentation – 4 th week of life ( range 2-8 weeks ) Cause – exactly not known but genetic/FH + and environmental - Syndromic/other anomalies

4. Presentation Well baby with Vomiting after feeding – non-bilious / non-projectile to begin with Constant hunger Stomach contraction Dehydration Weight loss constipation

5. Diagnosis History Clinical examination – olive shape mass and peristaltic movements - concentrated urine with high SG Lab parameter – normal stomach – Hcl + mucous vomiting – hypo-CL and metabolic alkalosis Jaundice ( icteropyloric syndrome)

6. Barium swallow delayed gastric emptying elongated pylorus with a narrow lumen (string sign) USG ( abdomen) Non invasive with good sensitivity and specificity Pyloric muscle thickness, i.e. diame­ter of a single muscular wall on a transverse image: >4 mm Pyloric transverse diameter: >14 mm Length, i.e. longitudinal measurement: >15 mm

7. Treatment –supportive and surgical Ramstedt pyloromyotomy – laparoscopic > open Sx

8. NURSING MANAGEMENT PRE-OP NPO-IVF, electrolyte correction Vitals monitoring Intake and output charting and daily weighing Maintain euthermia /euglycemia/asepsis

9. POST –OP care Local wound care and observe for complications - asepsis/dressing /ET & EG -watch for local infection -monitor stool /vomiting/AG distension -No bathing Pain management Non pharmacological – nesting /MOM/ Mother involvement Pharmacological- PCM drops Nutrition and fluids - MEN/ TPN /IVF -check Gut sounds

10. Parents education & baby follow up Local surgical site care Feeding training- EBM/KSF/DBF Oral Abs Check feed tolerance and weight gain/vaccination/OAE Follow up dates and timing instructions