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1. PYLORIC
STENOSIS
PresentedBy,
Ms.Ekta.S.Patel,
1
st
Year M.Sc
Nursing,
MSNDept.

3. Pyloricstenosisorpylorostenosisis
narrowing(stenosis)oftheopening
fromthestomachtothefirstpartofthe
smallintestineknownasthe
duodenum.
Thepylorus,meaning"gate".

5. Duetoenlargement(hypertrophy)ofthe
musclesurroundingthisopeningwhich
spasmswhenthestomachempties.
Thisconditioncausessevereprojectile
non-biliousvomiting.
Itmostoftenoccursinthefirstfewmonths
oflife.
Itmorespecificallylabelledasinfantile
hypertrophicpyloricstenosis.

6. Thethickenedpylorusisfeltclassicallyas
anolive-shapedmassinthemiddleupper
partorrightupperquadrantoftheinfant's
abdomen.

7. Pyloricstenosisalsooccursinadults,
wherethecauseisusuallyanarrowed
pylorusduetoscarringfromchronic
pepticulceration.

9. Pyloricstenosisisdefinedas
“narrowing(stenosis)oftheoutletof
thestomachsothatfoodcannotpass
easilyfromitintotheduodenum,
pyloricstenosisresultsinfeeding
problemsandprojectilevomiting.”

11. 3/1000livebirth
Male:Female=4:1
Commonlyinthefirstbornmalechild
Mostcommoncauseforlaparotomy
before1year.
Age3weeksto3months.
Childofthoseparentswhoaffected
withpyloricstenosis.
Itaffectmorecommonlychildthanthe
adult.

13. Idiopathic

14. Nitricoxidesynthesesdeficiency

15. Nervecelltheory(ganglioncelltheory)

16. Sex:Pyloricstenosisisseenmore
ofteninboys—especiallyfirstborn
children—thaningirls.

17. Race:Pyloricstenosisismore
commoninCaucasiansofnorthern
Europeanancestry,lesscommonin
African-AmericansandrareinAsians.

18. Premature birth:Pyloric stenosis is
more common in babies born
prematurely than in full-term babies.

19. Family history:
Studiesfoundhigher
ratesofthisdisorder
among certain
families. Pyloric
stenosisdevelopsin
about20percentof
maledescendantsand
10percentoffemale
descendants of
motherswhohadthe
condition.

20. Smoking during
pregnancy: This
behaviorcannearly
doubletheriskof
pyloricstenosis.

21. Earlyantibioticuse:Babies
givencertainantibioticsinthe
firstweeksoflife-erythromycin
totreatwhoopingcough,for
example-haveanincreased
riskofpyloricstenosis.In
addition,babiesborntomothers
whotookcertainantibioticsin
latepregnancyalsomayhave
anincreasedriskofpyloric
stenosis.

22. Bottle-feeding:Somestudiessuggest
thatbottle-feedingratherthanbreast-
feedingcanincreasetheriskofpyloric
stenosis.

23. Inadultitcanoccurduetohistory
ofpepticulcerinpylorusregionand
hypertrophicchangesinmuscle
layerofpylorus.

25. Persistentvomitingresultsinlossofstomach
acid(hydrochloricacid).
Asaconsequence,allingestedfoodandgastric
secretionscanonlyexitviavomiting,whichcan
beofaprojectilenature.
Thegastricoutletobstructionduetothe
hypertrophicpylorusimpairsemptyingofgastric
contentsintotheduodenum.

26. Thechloridelossresultsinalowbloodchloride
levelwhichimpairsthekidney'sabilitytoexcrete
bicarbonate.Thisisthesignificantfactorthat
preventscorrectionofthealkalosis.
Asecondaryhyperaldosteronismdevelopsdueto
thedecreasedbloodvolume.
Thevomitedmaterialdoesnotcontainbile
becausethepyloricobstructionpreventsentryof
duodenalcontents(containingbile)intothe
stomach.

27. Thehighaldosteronelevelscausesthekidneysto
avidlyretainNa
+
(tocorrecttheintravascular
volumedepletion),andexcreteincreasedamounts
ofK
+
intotheurine(resultinginalowbloodlevel
ofpotassium).
Thebody'scompensatoryresponsetothe
metabolicalkalosisishypoventilationresultingin
anelevatedarterialpCO
2

29. Signsofpyloricstenosisusually
appearwithinthreetofiveweeksafter
birth.
Pyloricstenosisisrareinbabiesolder
thanage3months.Signsand
symptomsinclude:

30. Vomitingafterfeeding.Thebabymayvomit
forcefully,ejectingbreastmilkorformulaup
toseveralfeetaway(projectilevomiting).
Vomitingmightbemildatfirstandgradually
becomemoresevereasthepylorusopening
narrows.Thevomitmaysometimescontain
blood.

31. Persistenthunger.Babieswhohave
pyloricstenosisoftenwanttoeatsoon
aftervomiting.

32. Stomachcontractions.Noticewave-
likecontractions(peristalsis)thatripple
acrossbaby'supperabdomensoon
afterfeeding,butbeforevomiting.This
iscausedbystomachmusclestrying
toforcefoodthroughthenarrowed
pylorus.

33. Dehydration.Babymightcrywithout
tearsorbecomelethargic.Youmight
findyourselfchangingfewerwet
diapersordiapersthataren'taswetas
youexpect.

34. Changesinbowelmovements.
Sincepyloricstenosispreventsfood
fromreachingtheintestines,babies
withthisconditionmightbe
constipated.

35. Weightproblems.Pyloricstenosis
cankeepababyfromgainingweight,
andsometimescancauseweightloss.

36. Oliveshapedmass“pylorictumor”at
anglebetweenrightrectusmuscleand
liver.

39. Infantilepyloricstenosisistypically
managedwithsurgery;veryfewcases
aremildenoughtobetreated
medically.
Thedangerofpyloricstenosiscomes
fromthedehydrationandelectrolyte
disturbanceratherthantheunderlying
problemitself.

40. Therefore,thebabymustbeinitially
stabilizedby correctingthe
dehydrationandtheabnormallyhigh
bloodpHseenincombinationwithlow
chloridelevelswithIVfluids.Thiscan
usuallybeaccomplishedinabout24–
48hours.

41. Intravenousandoralatropinemaybe
usedtotreatpyloricstenosis.Ithasa
successrateof85-89%comparedto
nearly100%forpyloromyotomy,however
itrequiresprolongedhospitalization,
skillednursingandcarefulfollowupduring
treatment.
Itmightbeanalternativetosurgeryin
childrenwhohavecontraindicationsfor
anaesthesiaorsurgery,orinchildren
whoseparentsdonotwantsurgery.

43. Laparoscopicpyloromyotomy

44. Fred-Ramstedt’sPyloromyotomy

46. Considerthermoregulationatall
times,
Beforetransporttotheatre,transfer
infanttoincubatorsetatneutral
thermal environment (NTE)
temperature.
Ensureincubatorwillbepluggedin
andpre-warmedfortheinfanttobe
transferredintoinrecovery.
Afterreturntotheward,ensure
temperatureisstablepriorto
transferringtoopencot.

47. Monitortemperaturehourlyuntilstable.
Routinepostanaestheticobservations.
Monitorwoundandreportabnormalities
tosurgeon.
Observeforbleeding,redness,swelling,
oozefromincisionsite.
Maintainadequatefluidbalancechart.
MonitorIVsite.
Ensureadequatepainrelief;usepain
assessmenttool.

49. Woundinfection
Incisionalhernia
Persistentvomiting
Stagnationgastritis
Mucosalperforation
Shock

51. Aslongaspyloricstenosisis
diagnosedquickly,theprognosis
(expectedoutcome)isexcellent.In
mostcases,surgerycuresthe
conditionandrelievesallsymptoms.
Mostinfantsrecoverfully,without
complications,andarenotat
increasedriskforfutureproblems
relatedtopyloricstenosis.

54. 1.
Whatisdefinitionof
pyloricstenosis?

55. 2.
Whatarethecausesof
pyloricstenosis?

56. 3.
Whatarethesignand
symptomsofpyloric
stenosis?

57. 4.
Whatarethediagnostic
evaluationofpyloric
stenosis?

58. 5.
Whatisofnurses
responsibilitywhile
handlingpatientwith
pyloricstenosis?

60. Topic:
Newtrendsintreatmentofpyloric
stenosis
Submit on: 27/03/2017