Pyloric Stenosis.pptx

It occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The patient has nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

1. Pyloric stenosis DR.ESWARAPPA S PROFESSOR SHRIDEVI COLLEGE OF NURSING TUMKUR

2. Pyloric Obstruction Pyloric obstruction, also called gastric outlet obstruction (GOO),occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The patient has nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

3. DEFINITION Pyloric stenosis is defined as narrowing of the outlet of the stomach so that food can not pass easily from it into the duodenum resulting in feeding problems and projectile vomiting . -- Pyloric stenosis or pylorostenosis is narrowing ( Stenosis )of the opening from the stomach to the first part of the samll intestine known as the duodenum . Pylorus meaning gate

4. Pyloric Stenosis Pyloric Stenosis  is characterized by hypertrophy of the circular muscle fibers of the pylorus, with a severe narrowing of the lumen. The pylorus is thickened to as much as twice its size, is elongated, and has a consistency resembling cartilage; as a result of this obstruction at the distal end of the stomach, the stomach becomes dilated.

5. Pyloric stenosis

6. Causes of pyloric stenosis Nitric oxide.  Impairment of this neuronal nitric oxide synthase ( nNOS ) synthesis has been implicated in infantile hypertrophic pyloric stenosis, in addition to Achalasia , (absent or ineffective peristalsis) (wavelike contraction) Diabetic gastroparesis - component of autonomic neuropathy resulting from type- 1and type -2

7. Causes of pyloric stenosis Genetic factors .  A nationwide study of nearly 2 million Danish children born between 1977 and 2008 shows strong evidence for familial aggregation and heritability of pyloric stenosis. Exposure to  antibiotics .   A cohort study found that treatment of young infants with macrolide antibiotics was strongly associated with infantile hypertrophic pyloric stenosis (IHPS). Premature birth In adult it can occur due to h/o peptic ulcer in pylorus region and hypertrophic changes in muscle layer of pylorus

8. RISK FACTORS FOR PYLORIC STENOSIS Smoking during pregnancy.  This behavior can nearly double the risk of pyloric stenosis. Early antibiotic use .  Babies given certain antibiotics in the first weeks of life — erythromycin to treat whooping cough, for example — have an increased risk of pyloric stenosis. In addition, babies born to mothers who took certain antibiotics in late pregnancy may have an increased risk of pyloric stenosis. Bottle-feeding .  Some studies suggest that bottle-feeding rather than breast-feeding can increase the risk of pyloric stenosis. Most of the people who participated in these studies used formula rather than breast milk, so it isn't clear whether the increased risk is related to formula or the mechanism of bottle-feeding.

9. Signs&Symptoms 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.  You may notice wavelike contractions (peristalsis) that ripple across your baby's upper abdomen soon after feeding but before vomiting. This is caused by stomach muscles trying to force food through the narrowed pylorus. Dehydration.  Your baby might cry without tears or become lethargic. You might find yourself 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.

10. Pathophysiology DUE TO ETIOLOGICAL FACTORS MARKED HYPERTROPHY AND HYPERPLASIA OF THE CIRCULAR AND LONGITUDINAL MUSCULAR LAYER OF PYLORUS NORMAL CELLS BECAME A HYPERTROPHY ANF HYPERPLASIA

11. PATHOPHYSIOLOGY PYLORIC CANAL BECOMES LENGTHENED AND THICKENED NARROWING OF GASTRIC ANTRUM IMPAIRED EMPTYING OF GASTRIC CONTENT PROJECTILE VOMITING

12. PYLORIC STENOSIS

13. Diagnosis Blood tests to check for dehydration or electrolyte imbalance or both Ultrasound to view the pylorus and confirm a diagnosis of pyloric stenosis X-rays of your baby's digestive system, if results of the ultrasound aren't clear More Information Ultrasound X-ray

14. SURGICAL INTERVENTION In pyloromyotomy, the surgeon cuts only through the outside layer of the thickened pylorus muscle, allowing the inner lining to bulge out. This opens a channel for food to pass through to the small intestine.

15. Medical management Treatment. The first form of treatment for pyloric stenosis is to identify and correct any changes in body chemistry using blood tests and intravenous fluids . Correction of electrolytes Pyloric stenosis is always treated with  surgery , which almost always cures the condition permanently.

16. After surgery Your baby might be given intravenous fluids for a few hours. You can start feeding your baby again within 12 to 24 hours. Your baby might want to feed more often. Some vomiting may continue for a few days.

17. Nursing Interventions Nursing interventions include monitoring  vital signs , airway patency, and neurologic status; managing pain; assessing the surgical site; assessing and maintaining fluid and electrolyte balance; and providing a thorough report of the patient's status to the receiving nurse on the unit, as well as the patient's family. Maintain adequate nutrition and fluid intake.   Provide mouth care. Promote family coping.