Hypertrophic Pyloric Stenosis . ppt..pptx

​Hypertrophic Pyloric Stenosis (HPS), or Infantile Hypertrophic Pyloric Stenosis (IHPS), is a common gastrointestinal condition in infants requiring surgical correction. It typically presents between 2 and 8 weeks of age.

1. HYPERTROPHIC PYLORIC STENOSIS Rukmaji Gingine

2. Introduction Hypertrophic pyloric stenosis is a common surgical condition of gastrointestinal tract during infancy which is characterized by hypertrophy of the two muscle layers of the pylorus resulting obstruction of the gastric outlet. Incidence ranges from 2 to 4 per 1000 live births. It is more commonly seen in males (4:1). It is usually manifested early in life, between 3 and 5 weeks of age, and majority of cases are identified in those aged 3-12 weeks.

3. Etiology Unknown Genetic: Monozygotic twins suggesting familial factors. High gastric parietal cell mass resulting duodenal hyperacidity Deficient production of neuronal nitric oxide synthase resulting impaired relaxation of pyloric smooth muscle. Use of macrolide antibiotics such as erythromycin in the first two weeks of life. Feeding methods: Transpyloric feeding in preterm infants. Associated other GI anomalies

4. Pathophysiology Hypertrophy and hyperplasia of smooth muscle of Pyloric sphintere. Narrowing of Pylorus ( partial complete obstruction) S tomach Content cannot flows easily through constricted pylorus V igorous peristalsis V omiting and dilated Stomach musculature

5. Clinical Features Nonbilious vomiting immediately after feeding which gradually becomes severe and projectile, contents of vomiting are gastric contents and occasionally streak of blood. Persistently hungry. Olive like mass can be felt at the lateral edge of the rectus abdominis muscle in the right upper quadrant of the abdomen especially after feed Visible peristaltic wave passing from left hypochondrium to umbilicus. Persistent and recurrent vomiting leading to dehydration Hypochloremic alkalosis Malnutrition and poor weight gain Irritability Jaundice may also be seen.

6. Diagnosis History of vomiting and palpation of masas . Ultrasound of abdomen showing thickened pyloric musculature (Pyloric muscle thickness >4 mm, pyloric muscle length >14-20 mm) Upper Gl barium study showing elongated pyloric canal (string sign) or thickened pyloric mucosa (double-track sign ) Upper Gl endoscopy Lab studies: Decreased serum potassium, sodium levels, increased pH and bicarbonate, decreased chloride level. increased hematocrit and elevated indirect bilirubin.

7. Management Fluid resuscitation Surgery : Surgery is planned only when fluid balance, acid-base status and electrolyte levels have been restored to normal. The classical operation is a Ramstedt pyloromyotomy in which there is a longitudinal incision of the pylorus with blunt dissection to the level of the submucosa, thus relieving the gastric outlet obstruction. Laproscopic pyloromyotomy may also be done. Endoscopic balloon dilatation of pylorus may be done when surgical risk is apprehended.

8. Nursing Management Assessment : Assess for frequency and amount of vomiting.Assess for signs of dehydration, electrolyte and acid-base imbalance Nursing Diagnosis : Fluid volume deficit related to effect of dehydration Imbalanced nutrition less than body requirement related to persistent vomiting secondary to pyloric obstruction . Risk for infection related to surgical repair. Acute pain related to surgical repair. Anxiety (parental) related to child's condition and outcome of surgery. Deficient knowledge related to home care.

9. Goal/Expected Outcome : The infant will be free of signs of dehydration . The infant will maintain adequate nutrition. The infant will be free from infection. The infant will exhibit signs of less pain. The parents will demonstrate less anxiety Nursing Intervention : Preoperative Care : Keep the child nil per mouth. Administer IV fluid according to the degree of dehydrationAdminister potassium chloride along with IV fluid as prescribed Watch for signs of dehydration and rehydration. Monitor serum electrolytes values. Maintain strict intake and output chart includin V fluids, blood products, emesis, urine, stool and NG drainage . Keep the infant warm and quiet. Elevate the head of the bed to prevent aspiration

10. Place the infant in high Fowler's position on right side after feeding to promote gastric emptying. Keep NG tube in place for drainage and observe the amount and characteristics of drainage. Monitor vital signs and daily weight.Explain the outcome of the surgery to the parents. Postoperative Care : Start feeding after the bowel sound has returned. Start feeding in small amount with oral electrolyte solution like pedialyte . Offer half strength formula initially and progress to full strength within 48 hours . Do not dilute breast milk. Increase amount of feeding only after the previous amount is well tolerated without episodes of vomiting. Continue IV fluid until sufficient amount of feed is takenand retained by the infant. Monitor vital signs and respiratory problems. Watch for signs of dehydration. Observe the surgical incision site for redness, swelling or drainage. Protect the incision site keeping the diaper low and change when wet.

11. Cont …… . Administer pain medication as prescribed. Record intake and output strictly . Inform the child's condition to the parents frequently . Allow the parents to participate in the care of their child . Provide instruction for diet and follow-up after discharge.

12. Summary Hypertrophic Pyloric Stenosis (HPS), or Infantile Hypertrophic Pyloric Stenosis (IHPS), is a common gastrointestinal condition in infants requiring surgical correction. It typically presents between 2 and 8 weeks of age.