Paeds: Pyloric stenosis

Question 1

S&S

Answer 1

1. Projectile vomiting (not bile stained) - increased frequency and severity with time.
2. Constant hunger
3. Hypochloraemic alkalosis with low plasma potassium (from vomiting acid stomach contents)
4. Weight loss/poor weight gain

Question 2

Risk factors

Answer 2

• Presents age 2-7 weeks (irrespective of gestational age)
• Boys: Girls = 4:1
• First borns
• FH (especially maternal)

Question 3

Pathophysiology

Answer 3

Hypertrophy of pylorus causing gastric outlet obstruction

Question 4

Diagnosis

Answer 4

1. Test feed
2. Ultrasound
3. If in doubt - Barium meal

Question 5

Test feed process

Answer 5

• Note gastric peristalsis (wave moving from left to right across abdomen)
• Pyloric mass or ‘olive’ palpable in RUQ
• If stomach over-distended with air, empty with nasogastric tube before palpation

Question 6

Management

Answer 6

• I.V. fluids to correct fluid and electrolytes
• CL and K deficits replaced
• Pyloromyotomy

Question 7

Pyloromyotomy

Answer 7

muscle, but not mucosa, og pylorus in cut

Question 8

Postoperative management

Answer 8

Fed next day, discharge 2-3 days