Pyloric stenosis

Question 1

What is pyloric stenosis?

Answer 1

Hypertrophy and hence narrowing of the pyloric sphincter

Sphincter: ring of smooth muscle forming the canal between stomach and duodenum

Question 2

What age does pyloric stenosis present?

Answer 2

Presents in 2nd-4th week of life

Question 3

What is the pathophysiology of projectilve vomiting in babies with pyloric stenosis

Answer 3

Increasing peristalsis in stomach after feeding → food ejected into oesophagus → projectile vomiting.

Question 4

What are the signs and symptoms of pyloric stenosis?

Answer 4

Non bilious projectile vomiting

Hungry baby that is thin pale and failing to thrive

Significant dehydration and electrolye abnormalities

May feel a palpable olive shaped mass in upper abdoen

Question 5

How to diagnose pyloric stenosis?

Answer 5

Abdominal US to visualise thick pylorus

Question 6

Due to the persistent vomiting what electrolyte abnormalities are expected?

Answer 6

Hypochloraemic, hypokalaemic and metabolic alkalosis

Question 7

How to manage Pyloric stenosis initially?

Answer 7

First step - IV resus to correct fluid and electrolyte balance before surgery

Question 8

What is the definitive management for pyloric stenosis?

Answer 8

Laparoscopic Pyloromyotomy (DEFINITIVE) →

incision is made in the smooth muscle of the pylorus to widen the canal allowing that food to pass from the stomach to the duodenum as normal.

Question 9

Why is bicarb high babies with pyloric stenosis?

Answer 9

Due to vomiting and loss of H+ ions, equilibrium will shift towards bicarb, will compensate over time after