Idiopathic Hypertrophic Pyloric Stenosis

Question 1

Arteries of stomach

Answer 1

4 major blood vessels

Left gastric artery
Right gastric artery
Left gastroepiploic artery
Right gastroepiploic artery

Question 2

Dominant artery of stomach

Answer 2

Left gastric artery

Question 3

Which artery bleeds in mallory weiss tear

Answer 3

Lft gastric artery

Question 4

Artery that bleeds in type 4 gastric ulcer

Answer 4

Lf gastric artery

Question 5

Even when we ligate 2 or more major vessels stomach does not undergo necrosis becoz

Answer 5

Extensive submucosal Anastomoses

Question 6

Another name for idiopathic hypertrophic pyloric stenosis

Answer 6

CHOD(congenital hypertrophic pyloric stenosis)

Question 7

Risk factors

Answer 7

M>F (4:1)
First born male child
Association with maternal erythromycin intake

Question 8

Clinical features

Answer 8

Normal at birth(dff b/w duodenal atresia)
sym start after 2-3 weeks
Projectile vommiting
Non bilious
No PEM

Question 9

Diagnosis

Answer 9

USG-Hypertrophied pylorus
(thickness >4mm length is >16mm)

Target sign
Antral nipple sign

X-ray
Single bubble sign
String sign
Double track sign
Mushroom sign

Question 10

Typical metabolic abnormalities in this pt

Answer 10

Hypochlorimic hypokalemic metablic alkalosis with paradoxical aciduria

Question 11

Best time to examine

Answer 11

During feeding
Visible peristalsis(lft-rt)
Palpable olive shaped swelling in epigastrium
Projectle vomiting

Question 12

Management

Answer 12

First correct dehydration and metabolic abnormalities

0.45% NS + Dextrose +kcl( only when renal function to cover and urine output adequate)

Question 13

Definitive surgery in this pt

Answer 13

Ramsteds pyloromyotomy

Question 14

Uneventful ramsted pyloromyotomy when to start feeding

Answer 14

4-6 hours after surgery

Mucosa repaired 24-48 hours