Pyloric stenosis notes

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1. Pyloric stenosis

2. Definition Pyloric stenosis is a narrowing of the pylorus, the opening from the stomach into the small intestine.

3. Cont… Pyloric stenosis  or  pylorostenosis  is narrowing ( stenosis ) of the opening from the stomach to the first part of the small intestine known as the duodenum, due to enlargement (hypertrophy) of the muscle surrounding this opening (the pylorus, meaning "gate"), which spasms when the stomach empties

4. Incidence Pyloric stenosis occurs most often in infants younger than 6 months. It is more common in boys than in girls.

5. Causes The cause of the thickening is unknown. Genes may play a role, since children of parents who had pyloric stenosis are more likely to have this condition.

6. RISK FACTORS Genes may play a role, since children of parents who had pyloric stenosis are more likely to have this condition

7. Pathophysiology Normally, food passes easily from the stomach into the first part of the small intestine through a valve called the pylorus. With pyloric stenosis , the muscles of the pylorus are thickened. This prevents the stomach from emptying into the small intestine.

8. Pathophysiology The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the duodenum. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature.

9. Clinical manifestation Vomiting is the first symptom in most children: Vomiting may occur after every feeding or only after some feedings Vomiting usually starts around 3 weeks of age, but may start any time between 1 week and 5 months of age Vomiting is forceful (projectile vomiting) The infant is hungry after vomiting and wants to feed again

10. Cont… Other symptoms appear several weeks after birth and may include: Abdominal pain Burping Constant hunger Dehydration Failure to gain weight or weight loss Wave-like motion of the abdomen shortly after feeding and just before vomiting occurs

11. Diagnosis The condition is usually diagnosed before the baby is 6 months old. A physical exam may reveal: Signs of dehydration, such as dry skin and mouth, less tearing when crying, and dry diapers Swollen belly Olive-shaped mass when feeling the upper belly, which is the abnormal pylorus Ultrasound of the abdomen  may be the first imaging test. Other tests that may be done include: Barium x-ray  -- reveals a swollen stomach and narrowed pylorus Blood tests -- often reveals an electrolyte imbalance

12. Treatment Treatment for pyloric stenosis involves surgery to widen the pylorus. The surgery is called pyloromyotomy . If putting the infant to sleep for surgery is not safe, a device called an endoscope  with a tiny balloon at the end is used. The balloon is inflated to widen the pylorus. In infants who cannot have surgery, tube feeding or medicine to relax the pylorus is tried.

13. Surgery The definitive treatment of pyloric stenosis is with surgical  pyloromyotomy  known as Ramstedt's procedure (dividing the muscle of the pylorus  to open up the gastric outlet). This is a relatively straightforward surgery that can possibly be done through a single incision (usually 3–4 cm long) or laparoscopically  (through several tiny incisions), depending on the surgeon's experience and preference .