Pyloric stenosis.pptx

Pyloric stenosis

1. Pyloric stenosis & CONGENITAL GASTRIC OUTLET OBSTRUCTION BY DR PULLA UMA MAHESWARI DEPARTMENT OF PAEDIATRICS PG PART - II

2. Pyloric stenosis is a thickening or swelling of the pylorus — the muscle between the stomach and the intestines — that causes severe and forceful vomiting in the first few months of life. It is also called infantile hypertrophic pyloric stenosis. It is common cause of gastric outlet obstruction in infants

3. INCIDENCE Pyloric stenosis is relatively common and occurs in approximately 2 to 5 infants per 1,000 live births. It is more prevalent in first-born males and is often diagnosed between 3 to 12 weeks of age.

4. CAUSES The enlargement of the pylorus causes a narrowing (stenosis) of the opening from the stomach to the intestines, which blocks stomach contents from moving into the intestine. The exact cause of pyloric stenosis is unknown. However, genetic factors are believed to play a role, as the condition tends to run in families.

5. There is genetic predisposition to the development of IHPS. In addition to the variability among races and clear male preponderance, there is an increased risk to the first born infants with a positive family history and certain ABO blood types, elevated gastrin levels, higher concentrations of neurotransmitter substance P and a decrease in nerve supporting cells in muscle layers have all been implicated in pylorospasm and muscle hypertrophy

6. RISK FACTORS Male sex (especially first-born boys) Parents or siblings who had pyloric stenosis Use of certain antibiotics (for example, erythromycin) during the first few weeks of life Smoking during pregnancy Bottle-feeding with formula

7. CLINICAL FEATURES 2 nd – 8 th week of life Projectile, frequent non bilious vomiting 30-60 mins after feeding Persistent hunger Jaundice (2%) – due to decreased glucoronosyl transferase associated with starvation On examination olive mass on upper abdomen

8. Persistent hunger: Despite feeding, infants with pyloric stenosis remain hungry due to the obstruction preventing proper food passage. Weight loss: The inability to retain and digest enough food often leads to poor weight gain or even weight loss. Dehydration: Vomiting can result in significant fluid loss, leading to dehydration, which may be accompanied by dry mouth, decreased urination, and sunken fontanelles (the soft spots on an infant's head). Constant hunger and irritability: Infants may become increasingly irritable and show signs of distress due to their hunger and inability to adequately feed.

9. After several days to weeks, infants become progressively dehydrated and lose weight. Some infants have a yellowish discoloration of the skin and the whites of the eyes (jaundice) at this point.

10. DIAGNOSIS Non-bilious projectile vomiting, visible gastric peristalsis and hypochloraemic hypokalemic metabolic alkalosis are cardinal features of IHPS. A definitive diagnosis can be made in 75% of the infants with IHPS by careful physical examination To be successful in palpating the pyloric olive, the infant must be calm and cooperative. The examiner should be ready to commit 5–15 minutes for proper examination. Examination with a pacifier or just after feeds could be more successful

11. Ultrasonography is the most common imaging technique for the diagnosis. The commonly used criteria on ultrasonography include a pyloric muscle thickness of 4 mm and a pyloric channel length of 16 mm or more. Blood Tests: Blood tests may be ordered to assess the infant's electrolyte levels and to check for signs of dehydration or other abnormalities.

12. TREATMENT The standard treatment for pyloric stenosis is surgery called a pyloromyotomy. The key to successful operation is the extramucosal operation of the pyloric muscle from near the pyloroduodenal junction well onto the normal stomach. Classical Pyloromyotomy ( Ramstedt Operation)

13. COMPLICATIONS If left untreated, pyloric stenosis can lead to severe dehydration, electrolyte imbalances, and malnutrition. Prompt diagnosis and treatment are crucial to prevent these complications. PROGNOSIS With appropriate treatment, the long-term prognosis for infants with pyloric stenosis is excellent. The surgery typically provides a complete resolution of symptoms, and infants can resume normal feeding and thrive .

14. CONGENITAL GASTRIC OUTLET OBSTRUCTION

15. Congenital gastric outlet obstruction refers to a blockage or narrowing in the region where the stomach empties its contents into the small intestine. It is a rare condition that occurs in infants and is present at birth (congenital). This obstruction prevents or hinders the normal passage of food from the stomach to the small intestine, leading to symptoms such as vomiting and feeding difficulties.

16. TYPES Pyloric Stenosis : This is the most common type, characterized by the thickening and narrowing of the pylorus, the muscular valve at the outlet of the stomach. Antral Web : A thin, membranous tissue forms across the outlet of the stomach, obstructing the passage of food.

17. Hypertrophic Pyloric Muscularis Propria : An overgrowth of the muscular layer of the pylorus causes narrowing and obstruction. Pyloric Atresia : Complete blockage or absence of the pyloric channel. Duplication Cyst : A cystic structure near the pylorus obstructs the flow of food

18. CLINICAL FEATURES Vomiting: Forceful, non-bilious vomiting typically occurs shortly after feeding. Abdominal Distention: The abdomen may appear swollen or distended. Failure to Thrive: Infants may experience poor weight gain and growth due to inadequate nutrition. Dehydration: Vomiting can lead to dehydration if fluids are not adequately replaced.

19. DIAGNOSIS Physical Examination: A mass or lump may be palpable in the abdomen, depending on the type and severity of the obstruction. Imaging Studies: Ultrasound is commonly used to visualize the pylorus and assess the degree of obstruction. An upper gastrointestinal series, which involves X-rays after the ingestion of contrast material, may also be performed. Laboratory Tests: Blood tests may be done to evaluate electrolyte imbalances, such as low levels of potassium due to vomiting.

20. TREATMENT Surgical Intervention: The primary treatment for congenital gastric outlet obstruction is surgery. The specific procedure depends on the type and severity of the obstruction. Examples include pyloromyotomy (surgical incision to relieve pyloric stenosis) or resection of the obstruction. Medical Management: Before surgery, infants may require intravenous fluids to correct dehydration and electrolyte imbalances.

21. COMPLICATIONS Malnutrition: Prolonged obstruction can lead to malnutrition and failure to thrive if not addressed promptly. Dehydration and Electrolyte Imbalances: Persistent vomiting can cause dehydration and imbalances in electrolyte levels, requiring medical intervention. Delayed Diagnosis: If the condition is not recognized and treated in a timely manner, there is an increased risk of complications and long-term effects on growth and development.

22. PROGNOSIS With appropriate treatment, the prognosis for infants with congenital gastric outlet obstruction is generally favorable. Most infants experience significant improvement in symptoms and can resume normal feeding and growth after surgical intervention.

23. HOMOEOPATHIC MANAGEMENT Although In allopathic system surgery is the only treatment.... but here HOMEOPATHY.... it shows wonderful result in pyloric stenosis, bringing back the hypertrophied muscles back to its normal size thus relieving from pain and distress and also the side effects of surgery on young ones.

24. RUBRICS

25. Aethusa Cynapium – Homeopathic Medicine for Reflux in Infants who Vomit After Intake of Milk Calcarea Carb – Natural Treatment for Gastric Reflux in Babies with Sour Smelling Vomiting Ornithogalum – painful contractions in the pylorus with duodenal distension , pain increased when food passes pyloric outlet. Vomiting of coffee g round looking matter Dysentery bacillus – spasm in pylorus , retention of digested contents , cyclical vomiting in children