Pyloric stenosis

Question 1

What is pyloric stenosis?

Answer 1

Hypertrophy of the outlet pyloric sphincter of the stomach

Question 2

Who is pyloric stenosis most common in?

Answer 2

Most common in firstborn boys from 3-8 weeks.
4:1 Boys > Girls

Incidence 1-3 per 1000 live births

Question 3

How does pyloric stenosis present?

Answer 3

Vomiting after feeds, can be projectile

Hypertrophic pyloric sphincter might be palpable as smooth olive sized mass in upper abdomen

Constipation and dehydration

Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting

Question 4

How is pyloric stenosis diagnosed?

Answer 4

Definitive diagnosis: abdominal ultrasound

Question 5

How is pyloric stenosis managed?

Answer 5

Correct electrolyte disturbance

Before surgery pass a wide bore nasogastric tube

Surgical management:

Ramstedt Pyloromyotomy to cut the pyloric sphincter to widen the outlet

Question 6

What are the complications of pyloric stenosis?

Answer 6

Severe vomiting => leads to an acid base abnormality of hypochloremic hypokalemic metabolic alkalosis.

=> this is due to loss of stomach hydrochloric acid.

=> loss of Cl- causes hypochloremia

=> loss of H+ causes alkalosis

=> loss of H+ results in increased renal reabsorption of H+ in exchange for K+.