Pyloric Stenosis Flashcards
What is pyloric stenosis?
It is defined as a condition in which there is thickening of the circular and longitudinal muscles of the pylorus
What is the pathophysiological consequence of pyloric stenosis?
This results in narrowing of the gastric outlet lumen, which is the opening between the stomach and the small intestine
Over time, this lumen will become completely obstructed – resulting in postprandial projectile vomiting
What four risk factors are associated with pyloric stenosis?
Infants, 2 – 6 Weeks Old
Male Gender
Family History
Firstborn Child
What are the nine clinical features of pyloric stenosis?
Failure To Thrive
Projectile Non-Bilious Vomiting
Increased Appetite
Weight Loss
Dehydration
Constipation
Palpable ‘Olive’ Pyloric Mass
Visible Gastric Peristalsis
Succussion Splash Bowel Sounds
When does vomiting occur in pyloric stenosis?
> 30 minutes of feeding
What three investigation are used to diagnose pyloric stenosis?
Arterial Blood Gas
Dextrose Water Feed Test
Ultrasound Scan
What arterial blood gas result indicates pyloric stenosis? Explain
Hypochloraemic hypokalaemic metabolic alkalosis
This is due to the loss of fluid, hydrogen and chloride through excessive vomiting
What is the dextrose water feed test?
It involves administration of a dextrose water feed, which should result in pyloric muscle contraction
What are the two features of pyloric stenosis on the dextrose water feed test?
Pyloric Mass
Projectile Vomiting
What is the most appropriate step following a positive dextrose water feed test result?
A diagnosis can be confirmed and there is no requirement for further imaging
What is the gold standard investigation used to diagnose pyloric stenosis?
Ultrasound Scan
What are the four features of pyloric stenosis on ultrasound scans?
Pyloric Muscle Thickness > 4mm
Pyloric Muscle Length > 18mm
Gastric Outlet Obstruction
Target Sign
What is the target sign?
It describes a hypertrophic hypoechoid muscle surrounding echogenic mucosa
What are the four immediate management options of pyloric stenosis?
Nil By Mouth
Nasogastric Tube Insertion
IV 0.9% Sodium Chloride Boluses
Electrolyte Correction
What is the surgical management option of pyloric stenosis?
Ramstedt Pyloromyotomy
