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pyloric stenosis

1. Pyloric stenosis

2. Outline Anatomy Histology Physiology Introduction Pathology Prevalence Cause Sings Symptoms Metabolic complications Diagnose Deferential diagnosis Treatment

3. The stomach is a 'j'-shaped organ, with two openings- the oesophageal and the duodenal- and four regions- the cardia, fundus, body and pylorus

4. The  pylorus  is the end of the stomach that connect it to the duodenum. It is divided into two parts, the  pyloric antrum , which connects to the body of the stomach, and the  pyloric canal , which connects to the duodenum by the pyloric orifice. The pyloric sphincter, or valve, is a strong ring of smooth muscle at the end of the pyloric canal which lets food pass from the stomach to the duodenum.

5. Histology Under  microscopy , the pylorus contains numerous  glands , including  gastric pits , which constitute about half the depth of the pyloric  mucosa . They consist of two or three short closed tubes opening into a common duct or mouth. These tubes are wavy, and are about one-half the length of the duct. The duct is lined by  columnar cells , continuous with the epithelium lining the surface of the  mucous membrane  of the stomach, the tubes by shorter and more cubical cell which are finely granular. The glands contain mucus cells and  G cells  that secrete  gastrin . The pylorus also contains scattered  parietal cells  and  neuroendocrine cells . These  endocrine  cells include  D cells , which release  somatostatin , responsible for shutting off acid secretion. (There is a second hormone-sensitive population near the  fundus .) Unstriated muscles, which are entirely involuntary, are located at the pylorus.

6. Histology

7. Function The pylorus is one component of the  gastrointestinal system . Food from the  stomach , as  chyme , passes through the pylorus to the  duodenum . The pylorus, through the pyloric sphincter, regulates entry of food from the stomach into the duodenum.

8. I ntroduction Pyloric stenosis is a narrowing of the pylorus, the opening from the stomach, into the small intestine. This type of blockage is also referred to as a gastric outlet obstruction. Normally, food passes easily from the stomach into the duodenum through a valve called the pylorus

9. Pathology Pyloric stenosis, which occurs as a result of the fibrous scar of the pyloric ulcer, in the first stage is due to the expansion and hypertrophy of the exchanged stomach. Finally, there comes a time when the mechanism of exchange is defeated, and this incident is very similar to the insufficiency of the enlarged ventricles of the heart as a result of valvular stenosis

10. Prevalence Pyloric stenosis is common between the ages of 50-60 years and the prevalence of this disease is more in men Adult idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare but well-defined entity in adults with only 200–300 cases reported so far in the literature According to the literatures pyloric stenosis rarely occurs in adults and its common dieses of childhood

11. Primary causes Neuromuscular disharmony due to changes in the vagus nerve. long-term pyloric spasm. Continuation of the narrowness of childhood.

12. Secondary Causes peptic ulcer cancer Ingestion of corrosive substances adhesions after an abdominal surgery Gastritis Idiopathic

13. Symptoms When the pyloric valve doesn't work properly, food stays in the stomach, and symptoms such as bloating, nausea, vomiting, reflux can occur. Eventually, if food can not get absorbed, weight loss occurs. Sometimes it is life-threatening.

14. signs vomiting . Stomach contractions. ... Dehydration. ... Changes in bowel movements. ... Weight problems Epigastric pain Succussion splash 

15. Metabolic complications and disturbances in patients with pyloric stenosis can be summarized as follows: 1 -the patient is dehydrated and the hematocrit level is high. 2- The amount of urine is small but concentrated, its interaction becomes alkaline at first and then acidic. 3- Chlorine, sodium and potassium levels in the serum decrease and plasma bicarbonate and urea increase

16. How is Pyloric Stenosis Diagnosed? 1 . Blood tests. These tests evaluate dehydration and mineral imbalances. 2. Abdominal X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. 3. Abdominal ultrasound. ... 4. Barium swallow/upper GI series

17. Deffrential diagnosis Carcinoma of the pyloric area scar along with a benign stomach ulcer near the pylorus, carcinoma of the pancreatic head occupying the duodenum and pylorus. Chronic pancreatitis Pyloric occupation with malignant lymph nodes Pyloric mass in adults

18. Treatment

19. The first form of treatment for pyloric stenosis is to identify and correct any changes in body chemistry using blood tests and intravenous fluids. Before surgery the patient should take Intravenous fluids/ NG tube/ recommended Foods rich in protein and vitamins Pyloric stenosis is always treated with surgery, which almost always cures the condition permanently. The operation, called a pyloromyotomy: In surgery to treat pyloric stenosis, the surgeon makes an incision in the wall of the pylorus. The lining of the pylorus bulges through the incision, opening a channel from the stomach to the small intestine. Surgery is needed to treat pyloric stenosis.

20. Cont… The elective operation for patients with pyloric stenosis is total vagotomy with gastrojejunostomy or billroth 2 mastectomy A minimally invasive approach to abdominal surgery, called laparoscopy is generally the first choice of surgery for pyloric stenosis. To perform laparoscopic surgery, the surgeon inserts a rigid tube (called a trocar) into the abdominal cavity through a small incision (cut). The tube allows the surgeon to place a small camera into the abdomen and observe the structures within on an external monitor. The abdomen is inflated with carbon dioxide gas, which creates room to view the contents of the abdomen and to perform the operation. Additional rigid tubes are placed through small incisions and used to insert small surgical instruments into the abdomen. These instruments are used together with the camera to perform the operation. Tubes and instruments are removed when the operation is finished and the incisions are closed with sutures (stitches) that are absorbed by the body over time.

21. Cont… Laparoscopic pyloromyotomy generally involves the use of two or three trocars, and therefore usually requires two or three small incisions. If the surgeon decides that a laparoscopic operation is not the best way to treat the problems that are found in the operating room, then the operation will be changed (converted) to use an older surgical technique. Conversion to a nonlaparoscopic operation (called an “open procedure”) is rare and requires a larger incision, which may take longer to heal.

22. Reference htto://emedicine.medscape.com/article/181753-overview#showall. Retrieved 28* Jan, 2016 Fendrick M, Forsch R etal . Pyloric stenosis Guidleines for Clinical Care. University of Michigan Health System May 2005 American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology 1998;114:579-81 . Krogfelt K, Lehours P, Mégraud F. Diagnosis of Helicobacter pylori Infection. Helicobacter 2005 10:s1 5 Meurer L, Bower D. Management of Helicobacter pylori Infection. American Family Physician Vol 65, No. 7, 2002 pp 1327-1336 Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy; The role of endoscopy in dyspepsia. Gastrointestinal Endoscopy Vol 54, No. 6, 2001 pp 815-817

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