pyloric stenosis .pptx

pyloric stenosis

1. PYLORIC STENOSIS BY M.C.Kniranda Ass istant P rofessor Dept of Child Health Nursing

2. Definition Pyloric stenosis is a medical condition in which the pylorus, the muscular valve between the stomach and the small intestine , becomes abnormally narrowed or obstructed, leading to the obstruction of the gastric outlet. This narrowing of the pylorus prevents the proper passage of food from the stomach to the small intestine.

3. Incidence Pyloric stenosis commonly occurs in infants , usually within the first few weeks of life . It is more common in males than females, with a male-to-female ratio of around 4:1.

4. ETI O L O GY The exact cause of pyloric stenosis is still unknown , but it is believed to have a multifactorial etiology. Genetic factors are thought to play a role, as there is a higher incidence of pyloric stenosis among siblings and family members. Environmental factors may also contribute to the development of the condition, but specific triggers remain unidentified . ( early postnatal exposure to antibiotics like erythromycin, maternal smoking etc.)

5. CLINICAL MANIFESTATIONS The hallmark symptom of pyloric stenosis is projectile vomiting , which occurs shortly after feeding. Vomitus is often non-bilious and may resemble curdled milk . Forceful vomiting that may project several feet away from the infant. Signs of hunger and irritability despite frequent feeding attempts.

6. Weight loss or poor weight gain. Dehydration and electrolyte imbalances due to excessive vomiting. Palpable “ olive-shaped ” mass in the epigastric region. Infants appear hungry, irritable, and unsatisfied after feeds.

7. DIAGNOSTIC EVALUATIONS Physical Examination: Palpation of the abdomen may reveal a palpable “olive-shaped” mass in the epigastric region, which represents the hypertrophied pylorus. The “olive” can often be felt when the infant is in a relaxed state and the stomach is empty. Abdominal Ultrasound: Abdominal ultrasound is the primary diagnostic tool for confirming pyloric stenosis.

8. MEDIC AL MAN A GEMENT Fluid and Electrolyte Management: Prior to surgery, infants with pyloric stenosis often require fluid resuscitation and correction of electrolyte imbalances caused by excessive vomiting. Intravenous hydration and electrolyte replacement may be necessary to restore the infant’s fluid and electrolyte balance. Atropine Therapy: In some cases, medical management with intravenous atropine may be attempted as a temporary measure to relieve pyloric spasm and improve the passage of food.

9. Atropine has been studied as a potential for conservative management of pyloric stenosis. It is either administered intravenously or orally with the goal of treatment being  cessation of projectile vomiting . 

10. However, surgical intervention remains the definitive treatment for pyloric stenosis, and atropine therapy is considered a temporary measure or a nonsurgical alternative in certain cases.

11. SURGICAL MANAGEMENT Surgical management of pyloric stenosis involves performing a pyloromyotomy . This procedure is typically done under general anaesthesia and can be performed as an open surgery or laparoscopically. A small incision is made in the hypertrophied pyloric muscle, relieving the obstruction and creating a wider pyloric channel. The goal is to restore normal passage of food from the stomach to the small intestine, allowing for improved feeding and resolution of symptoms.

12. Pyloromyotomy video

13. NURSING MAN A GE M ENT

14. Preoperative Nursing Care: Assess and monitor the infant’s vital signs, hydration status, and electrolyte balance. Provide supportive care and comfort measures to alleviate symptoms, such as frequent small feedings, burping, and upright positioning after feeds. Educate parents about the condition, the upcoming surgical procedure, and the expected postoperative care, addressing any concerns or questions they may have.

15. Postoperative Nursing Care: Monitor vital signs, surgical site, and signs of infection, such as fever, redness, swelling, or discharge. Administer prescribed pain medications and antibiotics. Observe for complications, such as bleeding or infection, and report any abnormalities to the healthcare team. Encourage early feeding and monitor for successful feeding tolerance, ensuring the infant is retaining and digesting food properly. Educate parents about postoperative care, including incision care, feeding techniques, and signs of potential complications, emphasizing the importance of follow-up visits and ongoing care.

16. NURSING DIAGNOSIS Imbalanced nutrition; less than body requirements related to inability to retain food Deficient fluid volume related to frequent vomiting Impaired oral mucous membrane related to NPO status Risk for impaired skin integrity related to fluid and nutritional deficit Compromised family coping related to seriousness of illness and impending surgery.