Pyloric Stenosis Flashcards

1
Q

What is pyloric stenosis?

A

A narrowing of the opening from the stomach to the first part of the small intestine (the pylorus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When does pyloric stenosis typically present?

A

2-8 weeks of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the time of presentation irrespective of?

A

Gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the underlying pathology in pyloric stenosis?

A

Hypertrophy of the pyloric muscle causing gastric outlet obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens as a result of gastric outlet obstruction?

A

Gastric contents cannot empty into the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can all ingested foods and gastric secretions exit the body in pyloric stenosis?

A

By vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the risk factors of pyloric stenosis?

A
  • C-section
  • Preterm birth
  • Bottle feeding
  • First born
  • Male gender
  • Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some symptoms of pyloric stenosis?

A
  • Vomiting
  • Hunger after vomiting
  • Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the vomiting experienced in pyloric stenosis?

A
  • Occurs within an hour of feeding
  • Increasing in frequency and forcefulness over time until projectile
  • Non-bilious
  • May contain blood due to oesophagitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When will hunger after vomiting drop off?

A

When dehydration leads to loss of interest in feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When can weight loss occur in pyloric stenosis?

A

When there is late presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the late signs of pyloric stenosis?

A
  • Dehydration
  • Weight loss
  • Malnutrition
  • Jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should a baby be examined for pyloric stenosis?

A

Test feed to calm the infant and allow abdominal examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What will abdominal examination show in an infant with pyloric stenosis?

A
  • Gastric peristalsis

- Pyloric mass in RUQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does gastric peristalsis look like?

A

A wave moving from left to right across the abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does a pyloric mass appear?

A

Feels like an olive

17
Q

What imaging may be useful in pyloric stenosis and why?

A

USS to confirm diagnosis prior to surgery

18
Q

What might biochemistry results show in pyloric stenosis?

A
  • Hypochloraemic metabolic alkalosis
  • Hyponatraemia
  • Hypokalaemia
19
Q

What can cause the abnormal biochemistry results?

A

Repeated vomiting of the stomach contents

20
Q

What are the differential diagnoses of pyloric stenosis?

A
  • Gastro-oesophageal reflux

- Intussusception

21
Q

What is the initial priority in managing pyloric stenosis?

A

Correcting any fluid and electrolyte disturbance with IV fluids

22
Q

Suggest a fluid plan for the management of initial fluid electrolyte losses in pyloric stenosis

A

0.45% saline with 5% dextrose and 20mmol/L potassium chloride at 120ml/kg/day

23
Q

How should stomach contents be managed?

A

Withhold feeds and empty stomach with NGT

24
Q

What is the definitive treatment for pyloric stenosis?

A

Pyloromyotomy

25
Q

What does pyloromyotomy involve?

A

Division of the hypertrophied muscle down to, but not including the mucosa

26
Q

How can pyloromyotomy be performed?

A

As an open procedure via the periumbilical incision or laparoscopically

27
Q

How soon can the child be fed post-operatively?

A

Usually ~6 hours

28
Q

How soon can the child be discharged post-operatively?

A

~2 days

29
Q

What are the complications of pyloromyotomy?

A
  • Perforation of mucosa

- Wound infection