Ch. 329.1 - Hypertrophic Pyloric Stenosis Flashcards
T/F Hypertrophic pyloric stenosis (HPS) is rare in Asians and more common in whites
T
HPS: Gender
M, especially firstborns
T/F: Offsprings of a mother and to a lesser extent the father who had pyloric stenosis are at higher risk for pyloric stenosis
T
Incidence of pyloric stenosis is increased with infants with what blood groups
B and O
Syndromes associated with pyloric stenosis
1) Eosinophilic gastroenteritis 2) Apert syndrome 3) Zellweger syndrome 4) Trisomy 18 5) Smith-Lemli-Opitz syndrome 6) Cornelia de Lange syndrome
Use of this drug is associated with risk of pyloric stenosis
Erythromycin, especially if given with 1st 2 weeks of life
Higher risk of pyloric stenosis is seen in female infants of mothers treated with ___ during pregnancy and breastfeeding
Macrolide antibiotics
Reduced levels of this substance is implicated in the pathogenesis of pyloric stenosis
Nitric oxide
Initial symptom of pyloric stenosis
Nonbilious vomiting, which may or may not be projectile initially but is usually progressive, occurring immediately after feeding
Vomiting in infants with pyloric stenosis usually starts at what age
3 weeks of age, but can develop as early as a week and as late as 5th month
Acid base abnormality seen in patients with pyloric stenosis with persistent vomiting
Hypochloremic metabolic alkalosis
MC clinical association of pyloric stenosis
Hyperbilirubinemia aka icteropyloric syndrome
T/F In icteropyloric syndrome, unconjugated hyperbilirubinemia is more common than conjugated
T
T/F Hyperbilirubinemia in icteropyloric syndrome usually resolves with surgical correction
T
Characteristics of the pyloric mass
Firm, movable, approx 2 cm in length, olive-shaped, hard, best palpated from the left side, and located above and to the right of the umbilicus in the midepigastrium beneath the liver’s edge
The pyloric “olive” is easiest palpated when
After an episode of vomiting
Diagnostic tool that confirms the diagnosis of pyloric stenosis in majority of cases
UTZ, sensitivity of approx 95%
Contrast studies of pyloric stenosis shows
1) String sign or an elongated pyloric channel; 2) shoulder sign or bulge of pyloric muscle into the antrum; 3) double tract sign or parallel streaks of barium seen in the narrowed channel
Preoperative treatment of pyloric stenosis is directed toward
Correcting fluid, acid-base, and electrolyte imbalance
Surgical procedure of choice for pyloric stenosis
Pyloromyotomy (Ramstedt procedure)
Successful management modality of infants with persistent vomiting secondary to incomplete pyloromyotomy
Endoscopic balloon dilation
Advisable mode of management for patients with pyloric stenosis who are not good surgical candidates
Nasoduodenal feedings
Pyloric muscle relaxant used in patients with pyloric stenosis when surgical treatment is not available
Atropine sulfate
