Pyloric stenosis

Question 1

Pathophysiology

Answer 1

Hypertrophy of smooth muscle of the pylorus

Question 2

Clinical features

Answer 2

Five times more common in boys
2-8 weeks old
Persistent, projectile, non-bilious vomiting
Infant remains hungry and eager to feed after vomiting
Weight loss, constipation, mild jaundice and dehydration occur after a few days
Causes hypochloraemic metabolic alkalosis

Question 3

Diagnosis

Answer 3

Clinical, palpation of hypertrophies pylorus during a test feed. Peristaltic waves may be visible
US abdo confirms
Hypochloraemic, hypokalaemic metabolic alkalosis (HCO3- elevated to 25-35) - due to loss of acidic gastric contents and kidneys retaining H+ at expense of potassium

Question 4

Management

Answer 4

Medical: correction of fluid and electrolyte abnormalities prior to surgical correction
Surgical: Ramstedt’s procedure - hypertrophied pyloric musculature divided