Pyloric stenosis Flashcards
Definition
Hypertrophy of pylorus- gastric outlet obstruction
Most important presenting feature
Progressive and projectile vomiting in 2-12 week old
Occurence
2-4/1000 live births
Sex predominance
Male 3:1
Is the first born or later born children more likely to develop
More common in first born
Is it common in preterm babies
Not common
Aetiology and association with other congenital abnormalities
Unsure, abnormal innervation
Genetic component
Association with gastriesophageal atresia and Hirschsprungs
Pathophysiology
Hypertrophy->constricted outlet->non bilous, projectile emesis->lose NaCl->metabolic alkalosis/dehydration->kidneys excretes K i exchange= hypochloremic, metabolic alkalosis with hypokalemia
What is the electrolyte imbalance seen exepected
Hypochloremic, metabolic alkalosis with hypokalemia
Symptoms
Progressive non bilous vomiting Hunger after vomiting Failure to thrive Dehydration Lethargy Yellow Constipation
Signs
Tachycardia Decreased wet nappies Dry mucus membrnes Sunken fontanelle Gastric peristaltic wave Palpable olive size in abdomen`
Diagnostic tests
Chemistry panel
ABG - metabolic alkalosis, hypochloremia, hyopokalemia
US abdomen- look at dimensions
Management
Call pediatric team
ABC
Need fluid resuscitation prior to surgery- Normal saline
1.5X maintanence 5% dextrose plus 1/2 NS
IVF not with potassium until urine output adequate
Pyloromyotomy, antibiotic prophylaxis
Post-operative management
Fast gastric decompression 24 hours, can feed the next day. D/C 2-3 days
Patient instructions (feeding, incision care, pain)
Feeding: small vomits expected. Keep bub sitting for 30mins after feedinh. If continues- contact surgeon.
Incision care: sponge bathing 2-3 days. Ask to call if discharge/redness/fever
Pain: should be mild, use paracetamol. Call if severe.
