Hypertrophic Pyloric Stenosis

Question 1

Def

Answer 1

In hypertrophic pyloric stenosis, the circular muscle of the pylorus becomes hypertrophied, causing thickness in the luminal side of the pyloric canal (Fig. 42.9). This thickness creates a gastric outlet obstruction, causing nonbilious vomiting that presents between weeks 3 and 6 of life.

Question 2

S/S

Answer 2

• Forceful, nonbilious vomiting, unrelated to feeding position
• Hunger soon after vomiting episode
• Weight loss due to vomiting
• Progressive dehydration with subsequent lethargy
• Possible positive family history
• hard, moveable “olive” in the right upper quadrant (hypertrophied pylorus)
• metabolic alkalosis (dehydration)

Question 3

Management/Tx

Answer 3

Management:
- If an easily palpable mass is felt, no further testing is necessary, and a surgical consult is called. If no mass is identified, a pyloric ultrasound may be ordered to identify a thickened hypoechoic ring in the region of the pylorus
- IV management
- After surgery, infants usually resume oral feedings after 1 to 2 days

Tx:
- surgical intervention (pyloromyotomy)