Pylori Stenosis

Question 1

Risk factors

Answer 1

• Typically first-born male children (4;1males to females),
• higher incidence in those with affected parents.
• Age 3–8 weeks.

Question 2

incidence

Answer 2

Incidence 1in 300 live births, but considerable regional variation.

Question 3

Pressing features

Answer 3

• Bile-free vomiting after every feed,
• becoming projectile.
• Hungry.
• Dehydrated: may vary from mild to severe hypovolaemia.
• Visible peristalsis in left upper quadrant from left to right.
• Palpable tumour.
• jaundice 2nd starvation
• ‘succession splash’ can be elicited via short feeds of oral glucose via ngt

Question 4

Biochemical Diagnosis

Answer 4

Hyperchloremic
Hyponatraemic
Metabolic alkaloids
Hypokalaemia

Question 5

Radiologic diagnosis

Answer 5

Pylori thickening >4mm

Length of >16mm

Question 6

Preoperative goals

Answer 6

Rehydrate
Correct electrolytes
Decompress stomach

Question 7

assessment for dehydration

Question 8

Correction of fluid deficit

Answer 8

Severed dehydration 20ml/kg bolus normal saline

Question 9

Maintenance fluid

Answer 9

5-10% dextrose with 1/2 saline

Add K 3mEq/kg/day When good renal function

Question 10

Resuscitation goals

Answer 10

Urine output z>1ml/kg/hr
HCO3 <28-30
Cl >90-100 mmol 
Na >130-135 mmol/l
K >3-3,5 mmol/L

Question 11

Surgical approach

Answer 11

Raised pyloromotomy periamb8lical

Laparoscopic

Question 12

Intraoperative

Answer 12

Suction NGT prior induction, turn baby side to side or lavage with saline until clear
Rapid sequence induction
Analgesia: local infiltration/regional paracetamol

Question 13

Postop