Hypertrophic pyloric stenosis (HPS).pptx

hypertrophic pyloric stenosis (HPS), causes a functional gastric outlet obstruction as a result of hypertrophy and hyperplasia of the muscular layers of the pylorus. In infants, hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction and the most common surgical cause of vomiting.

1. Hypertrophic pyloric stenosis (HPS)

2. Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis (HPS) is the most common gastric surgical disorder in neonates The thickened muscle creates a partial blockage (obstruction) that interferes with the passage of stomach contents into the small intestine. HPS is characterized by progressive hypertrophy of the circular muscle that surrounds the gastric pylorus. The progressive hypertrophy culminates in a high-grade or complete gastric outlet obstruction The precise etiology and pathogenesis is unclear

3. Hypertrophic pyloric stenosis

4. Causes several factors are thought to play a role in the development of HPS. There seems to a genetic predisposition environmental factors maternal smoking exposure to macrolide antibiotics

5. Sign and symptoms infants with HPS typically develop symptoms between 3 and 6 weeks of age. The predominant symptom is nonbilious forceful (“projectile”) emesis that occurs almost immediately after feeding If the vomiting has gone on for some time, there may be evidence of brown coloration or blood streaks from vomiting-induced gastritis or esophagitis. exhibits a robust appetite even after vomiting episodes. The inability to tolerate feedings may result in dehydration, lethargy, and failure to thrive.

6. Sign and symptoms… Dehydrated and lose weight . Yellowish discoloration of the skin and the whites of the eyes (jaundice) at this point. Hungry and feed well but retrograded movement of gastric content Undernourished

7. Diagnosis abdominal examination may reveal the hypertrophied pylorus as an olive-shaped mass at rectus abdominis muscle in the right upper quadrant laboratory abnormalities classically reveal hypochloremic , hypokalemic metabolic alkalosis Abdominal ultrasonography

8. Management Pyloromyotomy is the surgical treatment for HPS. Prior to surgery , dehydration and electrolyte abnormalities should be corrected. Multiple boluses with 10 to 20 mL/kg of 0.9% normal saline may be required to correct the hypovolemia. Maintenance fluid then can be started with 5% dextrose in 0.45% to 0.9% saline at 1.5 to 2.0 times the maintenance rate depending on the degree of dehydration Once urine output is established, 10 to 20 mEq /L of potassium chloride may be added to the IV fluid mixture

9. Management … Surgery may be delayed for 24 to 48 hours to correct dehydration and electrolyte abnormalities