Pyloric Stenosis

Question 1

Infantile pyloric stenosis occurs during which period

Answer 1

in the first 3–6 weeks of life.

Question 2

Nitric oxide is an essential chemical transmitter responsible for relaxation of the pyloric sphincter muscles. Studies have shown deficiency in nitric oxide synthase in the myenteric plexus in patients with infantile hypertrophic pyloric stenosis.
True or false

Answer 2

True

Question 3

Signs and symptoms include

Answer 3

projectile and non-bile-stained vomiting.

The child remains hungry and takes food immediately after vomiting.

• Poor weight gain and malnutrition
• Ninety-five percent have a palpable pyloric mass (olive sign) which is felt in the right upper abdomen, especially after vomiting and during a test feed.
• May be dehydrated.
• Visible peristalsis in the epigastrium travelling from left to right ( symptom of “sand clock”)

Question 4

Diagnosis is made by

Answer 4

Ultrasonography ( method of choice )
Abdominal radiograph
Barium Upper G.I series
Blood test

Question 5

Ultrasound diagnostic criteria for infantile pyloric stenosis is ?

Answer 5

pyloric muscle thickness is > 4 mm and the pyloric channel length is > 15 mm.

Question 6

Blood test in Infantile pyloric stenosis will reveal

Answer 6

hypokalemic, hypochloremic metabolic alkalosis.

Question 7

Abdominal radiograph in infantile pyloric stenosis will reveal ?

Answer 7

fluid-filled or air-distended stomach, suggesting the presence of gastric outlet obstruction. A markedly dilated stomach with exaggerated incisura (caterpillar sign) may be seen

Question 8

Upper G.I series in infantile pyloric stenosis will reveal?

Answer 8

narrowed pyloric canal filled with a thin stream of contrast material, a “string sign” or the “railroad track sign

Question 9

Treatment includes ?

Answer 9

correcting the dehydration and hypochloremic alkalosis with IV fluids. ½ normal saline with K + supplements.

Intravenous and oral atropine has been used to treat pyloric stenosis;

• surgery - Ramstedt pyloromyotomy

Question 10

Pyloromyotomy can be done through what approach

Answer 10

open procedure or laparoscopically

Question 11

Patients should be observed for which surgical complications?

Answer 11

− Incomplete pyloromyotomy
− Mucosal duodenal perforation
− Bleeding