Pyloric stenosis

Question 1

Define pyloric stenosis

Answer 1

Is a gastrointestinal disorder - pyloric sphincter is hypertrophied -> causing narrowing of the gastric outlet -> obstruction

Question 2

What is the relevant epidemiology of pyloric stenosis in paediatrics?

Answer 2

Affects 1-3 per 1,000 births
Age - predominantly in infants aged 6-8w
Gender - males 4:1
More common in caucasian infants
More common in premature infants

Question 3

What are the typical signs and symptoms of pyloric stenosis?

Answer 3

Postprandial vomiting - projectile, intensity and force inc with obstruction, non-bilious
Palpable mass - during or after feeding, hypertrophied ps -> smooth olive sized mass in RUQ or mid-epigastric
Reduced bowel movements
Persistent hunger and weight loss despite frequent feeds.

Question 4

What is the preferred imaging modality and diagnostic criteria for pyloric stenosis?

Answer 4

Abdominal ultrasound
Muscle length >16-18mm and thickness >3/4mm

Question 5

What electrolyte abnormalities can be seen in pyloric stenosis?

Answer 5

Hypokalaemic hypochloraemic metabolic alkalosis

Question 6

What is the typical management for pyloric stenosis?

Answer 6

Supportive - NBM and adminstered IV fluids, fluid resus and electrolyte correction
Definitive surgical intervention - Ramstedts pyloromyotomy - cut sphnicter to widen the outlet

Question 7

What are some potential complications of pyloric stenosis?

Answer 7

Metabolic alkalosis - persistent vomiting -> hypochloraemic, hypokalaemic.
Dehydration
Weight loss