Pyloric Stenosis Flashcards
What is pyloric stenosis?
A narrowing of the opening from the stomach to the first part of the small intestine (the pylorus)
When does pyloric stenosis typically present?
2-8 weeks of age
What is the time of presentation irrespective of?
Gestational age
What is the underlying pathology in pyloric stenosis?
Hypertrophy of the pyloric muscle causing gastric outlet obstruction
What happens as a result of gastric outlet obstruction?
Gastric contents cannot empty into the duodenum
How can all ingested foods and gastric secretions exit the body in pyloric stenosis?
By vomiting
What are the risk factors of pyloric stenosis?
- C-section
- Preterm birth
- Bottle feeding
- First born
- Male gender
- Family history
What are some symptoms of pyloric stenosis?
- Vomiting
- Hunger after vomiting
- Weight loss
Describe the vomiting experienced in pyloric stenosis?
- Occurs within an hour of feeding
- Increasing in frequency and forcefulness over time until projectile
- Non-bilious
- May contain blood due to oesophagitis
When will hunger after vomiting drop off?
When dehydration leads to loss of interest in feeding
When can weight loss occur in pyloric stenosis?
When there is late presentation
What are the late signs of pyloric stenosis?
- Dehydration
- Weight loss
- Malnutrition
- Jaundice
How should a baby be examined for pyloric stenosis?
Test feed to calm the infant and allow abdominal examination
What will abdominal examination show in an infant with pyloric stenosis?
- Gastric peristalsis
- Pyloric mass in RUQ
What does gastric peristalsis look like?
A wave moving from left to right across the abdomen
How does a pyloric mass appear?
Feels like an olive
What imaging may be useful in pyloric stenosis and why?
USS to confirm diagnosis prior to surgery
What might biochemistry results show in pyloric stenosis?
- Hypochloraemic metabolic alkalosis
- Hyponatraemia
- Hypokalaemia
What can cause the abnormal biochemistry results?
Repeated vomiting of the stomach contents
What are the differential diagnoses of pyloric stenosis?
- Gastro-oesophageal reflux
- Intussusception
What is the initial priority in managing pyloric stenosis?
Correcting any fluid and electrolyte disturbance with IV fluids
Suggest a fluid plan for the management of initial fluid electrolyte losses in pyloric stenosis
0.45% saline with 5% dextrose and 20mmol/L potassium chloride at 120ml/kg/day
How should stomach contents be managed?
Withhold feeds and empty stomach with NGT
What is the definitive treatment for pyloric stenosis?
Pyloromyotomy
What does pyloromyotomy involve?
Division of the hypertrophied muscle down to, but not including the mucosa
How can pyloromyotomy be performed?
As an open procedure via the periumbilical incision or laparoscopically
How soon can the child be fed post-operatively?
Usually ~6 hours
How soon can the child be discharged post-operatively?
~2 days
What are the complications of pyloromyotomy?
- Perforation of mucosa
- Wound infection
