Infantile Hyperthrophic Pyloric Stenosis (IHPS).ppt

Infantile hyperthrophy

1. Nigus Chanie ,MD

2. Session objectives
At the end of the lecture students will be able to:
Explain the clinical manifestations, Diagnostic criteria ,
Complications and management of a patient with IHPS.
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3. Session outline
Introduction
Epidemiology
Etiology
Clinical manifestations
Diagnosis/DDX
Complications
Management
Summary
References
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4. Introduction
Infantile hypertrophic pyloric stenosis (IHPS) is a
condition of hypertrophy of the pylorus, with
elongation and thickening, eventually progressing to
near-complete obstruction, of the gastric outlet.
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6. Epidemiology
Incidence :1-3/1,000 infants(USA)
race : more common in whites less common in blacks,
and rare in Asians.
Sex : Males :female ratio=4:1.
Hereditary :20% of the male and 10% of the female
descendants of a mother who had pyloric stenosis.
Common in infants with B and O blood groups.
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7. Etiology
In the majority of cases the cause is idiopathic
Multifactorial
Diminished nitric oxide synthase
Neonatal hypergastrinemia and gastric hyperacidity
Increased prostaglandins
environmental factors.
Macrolide antibiotics particularly erythromicin
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8. Associated anomalies
Eosinophilic gastroenteritis
Apert syndrome
trisomy 18
Midgutmalrotation
Hiatal hernia
Congenital heart disease
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9. Clinical manifestations
•Vomiting
Time 2-4wks
Nonbilious
projectile
progressive
After vomiting, the infant is hungry and wants to feed
again(hungry vomiter)
Loss /failure to gain weight
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10. Physical findings
Observe for signs of dehydration
under weight/marasmic
abdominal distension & gastric peristaltic waves
from left to right may be seen after feeding .
An olive-sized mass can be felt on deep palpation in
the right upper abdomen lateral to rectus abdominis
muscle.
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11. Gastric peristalsis and emaciation of a pt with IHPS
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12. Investigations
Complete blood count
Blood group and Rh
Urinalysis
Serum electrolytes
Serum PH
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13. Radiologic findings
Abdominal ultrasound diagnostic criteria
Pyloric muscle thickness:>=4mm
Pyloric canal diameter: >= 14 mm
Pyloric muscle length :>= 19 mm
Barium meal:
filling defect,
shoulder sign ,
beak sign ,and double tract sign
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14. Barium meal
showing shoulder
sign ,double tract
sign and beak signs
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15. Differential diagnosis
GERD
Gastric volvulus
Gastric webs
Gastric duplication
Congenital adrenal hyperplasia
Pylonephritis
Foreign bodies(bezors)
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16. Complications
Dehydration /shock
Electrolyte/acid base disturbances
Malnutrition
Unconjugated hyperbilirubinemia
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17. Management
Manage/prevent dehydration
Correct electrolyte disturbances
Surgery : Ramstedt pyloromyotomy
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18. Summary
IHPS
Commonly affect first born males
Present with nonbillous projectile vomiting after 2
nd
week of life
Eager to feed after vomiting
Gastric peristalsis
Ultrasound sensitive to detect in 95% with increased
thickness and diameter.
Pyloromyotomy
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19. References
Nelson text book of Pediatrics 18
th
edition
Current pediatric diagnosis and Treatment 18
th
edition.
Uptodate 17.1
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