Gastroenterology: Pyloric Stenosis Flashcards
Describe pyloric stenosis
Hypertrophy of the pyloric muscle causing gastric outlet obstruction
When does it present?
2-8 weeks of age, irrespective of gestational age
Is it more common in boys or girls?
Boys 4:1, particularly first born
Could there be a FH?
Yes, especially on maternal side
What clinical features are there?
Vomiting - increases in frequency and forcefulness over time, ultimately becoming projectile
Hunger after vomiting until dehydration leads to loss of interest in feeding
Weight loss if presentation delayed
Does a metabolic alkalosis or acidosis occur?
A hypochloraemic metabolic alkalosis occurs
A low plasma…. occurs
Sodium and potassium
How is a diagnosis made?
Unless immediate fluid resuscitation required, a test feed is performed
- baby given milk feed to calm infant and allow examination
- gastric peristalsis may be seen as a wave moving from left to right across abdomen
- feel for pyloric mass
Where can the pyloric mass be felt?
Right upper quadrant - feels like an olive
If the stomach is overdistended with air, what should be done before examination?
Emptied by nasogastric tube
What investigation may be helpful to confirm diagnosis before surgery?
USS
How is it managed?
Correct any fluid and electrolyte disturbance
Definitive: pyloromyotomy
What does a pyloromyotomy involve?
Division of hypertrophied muscle down to but not including the mucosa
