PYLORIC STENOSIS
Introduction
phyloric stenosis is also known as infantile
hypertrophic pyloric stenosis (IHPS) is the most
common cause of intestinal obstruction in infancy.
Infantile hypertrophic pyloric stenosis is a form of
gastric obstruction in gastric outlet which means a
blockage from the stomach to the intestine.
Immediate treatment for pylori Stenosis extremely
important ..
ANATOMY OF STOMACH:-
The stomach has four main anatomical divisions; the
cardia, fundus, body and pylorus:
Cardia – surrounds the superior opening of the
stomach
Fundus – the rounded, often gas filled portion superior
to and left of the cardia.
Body – the large central portion inferior to the fundus.
Pylorus – The pylorus is the end of the stomach that
connect it to the duodenum . It is divided into two
parts, the pyloric antrum, which connects to the body
of the stomach, and the pyloric canal, which connects
to the duodenum by the pyloric orifice.The pyloric
sphincter, or valve, is a strong ring of smooth muscle at
the end of the pyloric canal which lets food pass from
the stomach to the duodenum. It receives sympathetic
innervation from the celiac ganglion.
DEFINITION
The congenital hypertrophic
pyloric stenosis is defined as
functional gastric outlet
obstruction which result in
hyper trophy and hyperplasia
of muscular layer of the
pylorus.
INCIDENCE
This problem typically occurs in
infants between two and eight weeks
of age and effects one out of every
500 to 1000 live births. This disease is
more common in boy then girl..
PATHOPHYSIOLOGY
A diffuse hyper trophy and hyperplasia of smooth
muscle of antral region of stomach and pyloric sphicter
ETIOLOGY
1. Main cause of pyloric stenosis is
unknown.
2. GENETIC: Monozygotic twins suffering
familial factor
3. Deficiency in production of neuronalnitric
oxide synthase resulting Impaired
relaxation of pyloric smooth muscle
4. Use of macrolide antibiotics such
as erythromycin in the first two
weeks of life life
5. feeding methods:Transpyloric
feeding in preterm infants
6. Associated other G I Anomalies
CLINICAL
MANIFESTATIONS
1. Non bilious Vomiting immediately
after feeding which gradually
becomes severe and projectile,
contents of vomiting are gastric
contents and occasionally streak of
blood.
2. Persistently hungry
3. olive like mass can be filled at the
Lateral age of the rectus abdominal
muscle in the right upper quadrant
of the abdominal especially after feed
4.Visible Peristaltic wave passing from
left hypochondrium to umbilicus
5. persistent and recurrent vomiting
leading to her dehydration
6. Abdominal pain
7. Irritability
8.Constipation or starvation the diarrhea
9Jaundice maybe also seen.
INVESTIGATION
Baby’s finding Normal range
HB – 15.2 gm/dl 13.5-17.5 gm/dl
WBC – 12,100 cu 4500-11000
Platelet – 2.7lac/cc 150000
PCV – 45.2% 45-65%
BLOOD Neutrophil – 67% 45–75%
Lymphosil- 18%
Urea – 26 mg/dl
Creatinine – 1.3 mg/dl
Sodium – 140
Platelet – 3.6
USG
– pyloric muscle thickness >4mm
– Pyloric length 16 MM
– Gastric outlet obstruction
Medical management
fluid resuscitation – fluid management should focus
on collection of underlining dehydration and
electrolyte and acid base abnormalities. Initial Bolus
of 20 ML/KG 0.9% saline Should be used if the
infant is dehydrated. For maintenance 5% glucose
0.9% saline should be used.
Nasogastric Tube should be passed to decompress
the stomach
Surgical management
PYLOROMYOTOMY:- A Surgical procedure
Called PYLOROMYOTOMY, which involves cutting
through the chicken muscle of the pylorus,Is performed
to relieve the blockage that results from the pyloric
stenosis
Complication
1. Duodenal perforation
2. Persistent vomiting due to incomplete pylorictomy
3. Dehydration, weight loss, severe electrolyte
imbalance.
4. FCH (foveolar cell hyperplasia) Has been reported as
a rare cause of persistent gastric outlet obstruction
obstruction
Prognosis
Diagnosis is excellent unless
diagnosis is delayed and
prolonged severe dehydration
of course
Mortality is rare after
pyloromyotomy
Conclusion
Hypertrophic pyloric stenosis should
be kept in mind in any child presents
with growth retardation non-Bilious
vomiting besides metabolic
derangement after exclusion of
medical causes..
