Chapter 24: Hypertrophic Pyloric Stenosis (Children)

Question 1

Hypertrophic Pyloric Stenosis

Answer 1

obstructive GI disorder

• thickening or narrowing of the pylorus, a muscle in the stomach
• usually occurs in healthy male infant

Question 2

Causative factors

Answer 2

etiology unknown

• casual theories: deficiency in inhibitory neuronal signals
• molecular causes: ganglionic cell immaturity

Question 3

Signs and Symptoms

Answer 3

there is a pattern of normal feedings and new onset of nonbilious vomiting
-the vomiting usually begins with episodes of regurgitation during the first few weeks of life
-vomiting usually occurs immediately after a feeding and may become projectile in nature
-infant generally appears hungry immediately after vomiting and eagerly wants to feed again
>other symptoms:
-insatiable appetite
-weight loss
-dehydration
-constipation
-olive-shaped mass
-visible reverse, or left to right, peristalsis may be observable in the left upper quadrant

Question 4

Most common symptom of hypertrophic pyloric stenosis

Answer 4

projectile vomiting

Question 5

Diagnosis

Answer 5

can be made by palpating the pyloric mass; is olive-shaped, moveable, and firm
-best palpated from the left side and located above and to the right of the umbilicus in the mid-epigastrium (the superior central portion of the abdomen) beneath the liver edge
-abdominal x-ray may show an enlarged stomach with diminished or absent gas in the intestine
-examination of pylorus on ultrasound shows elongation and thickening of the pylorus; confirmed by a barium upper GI series
>confirmation by upper GI series demonstrates a “string sign” which is caused by the barium passing through a narrowed pylorus

Question 6

What would a upper GI series demonstrate when confirming Hypertrophic pyloric stenosis

Answer 6

• “string sign”

- caused by the barium passing through a narrowed pylorus

Question 7

Ultrasound

Answer 7

shows elongated muscular mass surrounding a long pyloric canal
-ultrasound confirms the diagnosis

Question 8

Prevention

Answer 8

may not be prevented

-good prenatal care promotes optimal fetal development in utero

Question 9

Nursing Care

Answer 9

• history and assessment of child
• be alert to signs of dehydration (e.g. changes in skin turgor, appearance of the mucous membranes, depressed fontanelles, presence or absence of tears, urine output, changes in vital signs, weight loss, and evidence of discomfort)
• dehydration imbalance corrected with IV fluids and administration of appropriate electrolyte therapy
• NPO before surgery

Question 10

Surgical Care: pyloromyotomy

Answer 10

pyloromyotomy (incision and suture of the pyloric sphincter)

• performed by laparoscopy (abdominal exploration) with an endoscope
• pyloric mass is split without cutting the mucosa and the incision is closed

Question 11

Postoperative care

Answer 11

• monitoring of vital signs frequently
• communicates to the family that it is common for the infant to experience some vomiting in the first 24 to 36 hours after surgery
• fluid balance is maintained through IV fluids and oral liquids as tolerated
• whether or not bowel sounds are present, feeding begins 6 hours after surgery
• continue to monitor signs of dehydration and infants response to oral fluids
• save wet diapers that are weighed to measure output
• monitor site for infection, keeping wound clean and dry
• provide pain relief
• change wet or soiled diapers ASAP for children who are not toilet trained

Question 12

Education/ Discharge

Answer 12

• care of the incision and observation for signs of infection
• observe infant’s response to feedings b/c some vomiting may still occur within the first 48 hours postoperatively
• vomiting beyond 48 hours must be reported