Gastro - Pyloric Stenosis

Question 1

What happens in pyloric stenosis?

Answer 1

Pyloric sphincter between stomach and duodenum hypertrophies

Narrows the pylorus, preventing food from travelling from stomach to duodenum

Projectile vomiting with the powerful peristaltic contractions

Question 2

How does pyloric stenosis present?

Answer 2

• First few weeks of life
• Hungry baby
• Thin
• Pale
• Failing to thrive
• Projectile vomiting

Question 3

How does pyloric stenosis present on examination?

Answer 3

If during feeding, can see the peristalsis in abdomen

Firm, round mass felt in upper abdomen
Feels like a large olive due to pyloric hypertrophy

Question 4

What does a blood gas show in pyloric stenosis?

Answer 4

Hypochloric metabolic alkalosis

Baby is losing HCl from vomiting

Question 5

How is pyloric stenosis managed?

Answer 5

Diagnosis with abdominal USS, to visualise thickened pylorus

Treatment involves laparoscopic pyloromyotomy

Question 6

What happens in a laparoscopic pyloromyotomy?

Answer 6

AKA Ramstedt’s operation

Incision made in smooth muscle of pylorus to widen canal

Allows food to pass to duodenum

Excellent prognosis