only for teaching

1. INFANTILE HYPERTROPHIC PYLORIC
STENOSIS(IHPS)
• An overview
prepared & presented by
Abdalla H. Rashid
MD/3/15/121/TZ
SUZA

2. CONTENTS
Definition,
etiology,
risk factor,
pathophysiology,
clinical feature,
, diffential diagnosis
, complication of (IHPS)
Proper diagnosis and curative manegement

5. • Definition
Pyloric stenosis is is hypertrophy of
musculature of pyloric Antrim,especially the
circular muscle fibers causing primary failure
of pylorus to relax

6. Epidermiology
1. 2-3.5 live birth
2 .Male:Female 4:1
3 . 3-5 weeks of life
4. Preterm baby
5. First born child for 30%

7. Risk factor and etiology
Risk factor /etiology
1.Maternal smoking or alcholism
2.Bottle feeding
3.Genetical history/family history of IHPS
4.Microide like erythromycin/azithromycin

8. pathophysiology

9. Clinical feature
VOMITING
postprandial, projective and non bilious
VORACIOUS APPITITE
This condition develop soon after vomiting
FAILURE TO THRIVE
due to malnutrion

10. signs
1.Sunken eye
2.Sunken anterior frontanale
3.Dry mouth
4.Lethagic
5.Low urine output
All of this due to dehydration

11. On inspection
1.VGP
2.Occasional jaundice (preterm baby)
On palpation
Olive mass

13. inverstigation
1 .Abdominal x rays; dilated stomach
2. Barium meal series ;string sign and rail roads
sign
3 USG show dilated and elongated pyloric
stenosis I.E doughnut appearance
4; serum electrolyte ( hypo Na,K,cl)
5 RFT

16. Diagnostic criteria of IHPS
Rohrscchneider
1 .Pyloric channel length; 1.5 to 2cm
(normal 1cm)
2. pyloric channel diameter ;1.3 to 1.5cm
(normal 1 cm)
3. Circular muscle thickness ;4 to 5 mms
(normal < 2mms

17. Diffential diagnosis
1 .duodenal atresia( bilious vomiting present
too)
2 High intesine obstruction( volvulus
neonstorum)
3 Intercranial haemorrhage
4 GERD
5 Congenital like pyloris atresia or membrane
and antral atresia or membrane

18. Complications of pyloric stenosis
1. Hypovolemic shock due to severe vomiting
that lead severe dehydration
2. Acute kidney injury due to hypovolemic
shock
3. Electrolyte imbalance
4. failure to thrieve
5. metabolic disturbance due to metabolic
alkalosis

19. management
conservative treatment
1 NPO
2 NGT & gastric lavage
3 IV fluid to correct dehydration and alkalosis
with D5W & Kcl

20. Curative treatment
Fredet – Ramstedts pyloromyotomy
laparoscopic pylomyotomy

21. complication
Occasional complications are — (i)
postoperative vomiting — this may be
treated by repeated
aspiration and intravenous feeding, (ii)
postoperative pyrexia, (iii) gastroenteritis —
all these can be
treated by antibiotic and tepid sponging with
repeated aspirations, and (iv) disruption of
wound

22. Reference
1 Surgery srb
2 S das surgery
3 medscape