Pyloric Stenosis

Question 1

What is the Pyloric Sphincter?

Answer 1

• The Pyloric Sphincter is a ring of smooth muscle between the stomach and the duodenum
• Hypertrophy of the pylorus is called pyloric stenosis
• This thickening prevents food from travelling from the stomach to the duodenum as normal

Question 2

What is the Pathophysiology of the vomiting in Pyloric Stenosis?

Answer 2

• After feeding there is an increasingly powerful peristalsis in the stomach as it tries to push food into the duodenum
• It becomes so powerful it eventually leads to food ejecting across the room = Projectile vomiting

Question 3

What are the features of Pyloric Stenosis?

Answer 3

• Presents as a hungry baby that is thin, pale and generally failing to thrive
• Projectile vomiting
• “large olive” round mass felt in the upper abdomen, this is caused by the hypertrophic muscle of the pylorus
• Peristalsis seen in the abdomen

Question 4

What does the blood gas show for Pyloric Stenosis?

Answer 4

• Hypochloric Metabolic Alkalosis
• As the baby is vomiting hydrochloric acid from the stomach

Question 5

What investigation is used to make a diagnosis of Pyloric Stenosis?

Answer 5

• Abdominal USS to help visualise the thickened pylorus

Question 6

What is the managment of Pyloric Stenosis?

Answer 6

• Laparoscopic pyloromyotomy (Ramstedt’s Operation)
• An incision is made in the smooth muscle of the pylorus to widen the canal allowing food to pass from the stomach to the duodenum