Pyloric stenosis

hypertrophy of the pyloric mm
1. -> gastric outlet obstruction
epidemiology
1. presents btw 2-7 weeks of age
  1. regardless of gestational age
2. commoner in boys (4:1)
  1. especially 1st borns
3. family hx present
  1. esp on maternal side
clinical features
1. vomiting
  1. increases in freq and forcefulness w/ time
    1. ultimately becomes projectile
2. hunger after vomiting
  1. until dehydration -> loss of interest in eating
3. weight loss
  1. if presentation delayed
4. hypochloraemic metabolic alkosis w/ low Na+ and low K+
  1. due to vomiting stomach contents
diagnosis
1. test feed
  1. done unless immediate fluid resus needed
  2. milk feed given
    1. hungry infant becomes calm
      1. allows examination
2. on examination
  1. gastric peristalsis observed
    1. wave moving from left to right across abdomen
  2. palpable pyloric mass
    1. feels like an olive
    2. in right upper quadrant
  3. if stomach distended with air
    1. empty with NG tube so you can palpate it
  4. possible dehydration
3. if diagnosis in doubt
  1. ultrasound
Mx
1. 1. correct any fluid & electrolyte disturbance
  1. iv 0.45% saline and 5% dextrose w/ K+ supplements
2. 2. pylormyotomy
  1. once hydration, acid-base and electrolytes normal
  2. definitive treatment
  3. involves division of hypertrophied mm down to, but not including the mucosa
  4. open procedure via periumbilical incision or laparoscopically
  5. post op child can eat within 6hrs and be discharged within 2 days of surgery

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Pyloric stenosis

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