Pyloric stenosis

gastrointestinal disorder

1. Pyloric stenosis Mrs. Nibi mol baby Associate professor

2. OVERVIEW The pylorus is a muscular valve located between the stomach and the small intestine. It’s the exit point of the stomach and the gateway to the duodenum of the small intestine. It helps the stomach hold food, liquids, acids, and other matter until they are ready to move on to the small intestine and be further digested and then absorbed. For reasons that aren’t entirely understood, the pylorus can sometimes thicken and cause luminal narrowing. This is called pyloric stenosis.

3. DEFINITION Pyloric stenosis is defined as “narrowing (stenosis) of the outlet of the stomach so that food cannot pass easily from it into the duodenum, pyloric stenosis results in feeding problems and projectile vomiting. Narrowing (stenosis) of the opening from the stomach to the first part of the small bowel (duodenum), due to enlargement (hypertrophy) of the pylorus.

4. INCIDENCE/RISK FACTORS Sex.  Male babies, especially first-born males, are more at risk than females. Family history.  Roughly  15 percent  of babies with the condition have a family history of the disorder. A baby born to a woman who had the condition as an infant is  three times  more likely to have pyloric stenosis. Race.  The condition is most likely to affect Caucasians of Northern European descent. It’s less common in African-Americans and Asians. Smoking tobacco.  Smoking during pregnancy almost  doubles  the chance of giving birth to a baby with pyloric stenosis.

5. CONT… Bottle feeding.  In a  2012 studyTrusted Source , infants who were bottle fed had a higher risk for pyloric stenosis, being at least four times as likely to develop the condition than those who weren’t bottle fed. Experts in this study could not determine exactly if the higher risk was because of the feeding mechanism itself, or if breast milk versus formula during the feedings also contributed to the increased risk. Antibiotic use.  The use of certain antibiotics early in life can increase a baby’s risk of pyloric stenosis. One  study  suggests that infants given antibiotics in the first two weeks of life had the greatest risk.

6. CLINICAL FEATURES Vomiting after feeding.  The baby may vomit forcefully, ejecting breast milk or formula up to several feet away (projectile vomiting). Vomiting might be mild at first and gradually become more severe as the pylorus opening narrows. The vomit may sometimes contain blood. Persistent hunger.  Babies who have pyloric stenosis often want to eat soon after vomiting. Stomach contractions. may notice wavelike contractions (peristalsis) that ripple across baby's upper abdomen soon after feeding but before vomiting. This is caused by stomach muscles trying to force food through the narrowed pylorus.

7. CONT…… Dehydration.  baby might cry without tears or become lethargic. might find changing fewer wet diapers or diapers that aren't as wet as you expect. Changes in bowel movements.  Since pyloric stenosis prevents food from reaching the intestines, babies with this condition might be constipated. Weight problems.  Pyloric stenosis can keep a baby from gaining weight, and sometimes can cause weight loss.

8. DIAGNOSTIC EVALUATION PHYSICAL EAMINATION EVERLY MALNURISHED INFANTS BARIUM MEAL X-RAY USG BLOOD IVESTIGATION

9. Medical management Infantile pyloric stenosis is typically managed with surgery; very few cases are mild enough to be treated medically. The danger of pyloric stenosis comes from the dehydration and electrolyte disturbance rather than the underlying problem itself. Therefore, the baby must be initially stabilized by correcting the dehydration and the abnormally high blood pH seen in combination with low chloride levels with IV fluids. This can usually be accomplished in about 24– 48 hours

10. CONT… Intravenous and oral atropine may be used to treat pyloric stenosis. It has a success rate of 85-89% compared to nearly 100% for pyloromyotomy, however it requires prolonged hospitalization, skilled nursing and careful follow up during treatment. it might be an alternative to surgery in children who have contraindications for anesthesia or surgery, or in children whose parents do not want surgery.

11. SURGICAL MANAGEMENT Laparoscopic pyloromyotomy. Fred- Ramstedt’s Pyloromyotomy

12. NURSING MANAGEMENT Preoperative management observe and record vital signs of the infant as they help in detecting and proven electrolyte imbalance . note and record the amount and characteristics of monitors and stool . stop order feeding and administrate intravenous fluid as prescribed is Olivia allowed then feed the infant in semi upright position . Feed slowly and BURP frequently to prevent vomiting. After saving make the infant lie and head end of the bed is elevated to promote gastric and empty . place the baby in the right sideline on p rone position .

13. Continue Give small frequent feeds. w eigh the infant daily, in order to determine the degree of dehydration. Maintain strict intake and output chart. Provide warmth to the infant and protect from infection . prior to surgery gastric l a vage is done with isotonic normal saline . fluid and electrolyte losses must be corrected, 24 to 48 hours before surgery .

14. Post operative nursing care. First observe for signs of complications management of pain. provision of adequate fluid and nutrition parental education and follow up after surgery

15. Complications WOUND infection incisional hernia Persistent vomiting stagnation gastritis mucosal perforation shock

16. Nursing diagnosis fluid volume deficit belated to frequent vomiting as evidenced by dry skin and mucous membrane . imbalanced nutrition less than body requirement related to vomiting as evidenced by weight loss . impaired skin integrity related to surgery as evidenced by observation . anxiety of parents related to hospitalisation and surgery of child as evidenced by frequent questioning of parents . risk for injury related to post operative complication