Congenital (infantile) hypertrophic pyloric stenosis by Dr.K.AmrithaAnilkumar

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CONGENITAL (INFANTILE) HYPERTROPHIC PYLORIC STENOSIS DEFINITION It is hypertrophy of musculature of pyloric antrum, especially the circular muscle fibres, causing primary failure of pylorus to relax. Duodenum is normal.

Health & Medicine

en love da Homoeopathy
CONGENITAL
(INFANTILE)
HYPERTROPHIC
PYLORIC
STENOSIS

CONGENITAL
(INFANTILE)
HYPERTROPHIC
PYLORIC
STENOSIS

CONGENITAL(INFANTILE)
HYPERTROPHICPYLORIC
STENOSIS
DEFINITION
• It is hypertrophyof
musculature of pyloric
antrum, especially the
circular musclefibres,
causing primary failure
of pylorus to relax.
• Duodenum is normal.

CLINICALFEATURES
• Common in first born males
(4:1).
• ncidence is 4 in 1000 births.
• It is familial.
• It is seenbetween3rd and 6th
weeks of age of an infant, the
time takenby the
hypertrophied muscle to
cause complete obstruction.
• Vomiting—forcible,
projectile and non-bilious.
• Visible gastric peristalsis
(VGP).
• Palpable lumpof
hypertrophied pylorus
whichis better felt
• fromleft side,
• as a mobile,
• smooth,
• firm,
• olivelike mass,
• with all borders well
madeout,
• moves with
respiration, with
impairedresonance
on percussion.

• Constipation.
• Dehydrationand loss of
weight.
• Electrolyte imbalance—
hypokalaemic
• Metabolicalkalosis
• Anorexia
INVESTIGATION
• Ultrasoundabdomen
(veryuseful)—
Doughnut sign.
• Pyloric muscle 4 mm or
more in thickness.
• Lengthof pyloriccanal
>14 mm.
• Cervix signon long axis,
target sign on short axis.

• Bariummeal shows
obstruction.
• Contrast studyis not
commonly done
• but whenit is done, it shows
‘string sign’ or ‘railroad
tracksign’ or ‘double track
sign’ with pyloric
obstruction
DIFF. DIAGNOSIS
• Duodenal atresia (Bilious
vomiting is present).
• High intestinal obstruction
(e.g. volvulus neonato rum).
• Intracranial haemorrhage.
TREATMENT
• Correctionof dehydration
and electrolyte imbalance.
• Surgery: Ramstedt’s
operation
• Endoscopicpyloromyotomy

REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

A
Special Thanks
To A Very
Special Doctor

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PYLORIC STENOSIS Pyloric stenosis is a medical condition in which the pylorus, the muscular valve between the stomach and the small intestine, becomes abnormally narrowed or obstructed, leading to the obstruction of the gastric outlet. This narrowing of the pylorus prevents the proper passage of food from the stomach to the small intestine. The exact cause of pyloric stenosis is still unknown, but it is believed to have a multifactorial etiology. Genetic factors are thought to play a role, as there is a higher incidence of pyloric stenosis among siblings and family members. Environmental factors may also contribute to the development of the condition, but specific triggers remain unidentified. The hallmark symptom of pyloric stenosis is projectile vomiting, which occurs shortly after feeding. Vomitus is often non-bilious and may resemble curdled milk. Forceful vomiting that may project several feet away from the infant. Signs of hunger and irritability despite frequent feeding attempts. Weight loss or poor weight gain. Dehydration and electrolyte imbalances due to excessive vomiting. Palpable “olive-shaped” mass in the epigastric region. Infants appear hungry, irritable, and unsatisfied after feeds. Physical Examination: Palpation of the abdomen may reveal a palpable “olive-shaped” mass in the epigastric region, which represents the hypertrophied pylorus. The “olive” can often be felt when the infant is in a relaxed state and the stomach is empty. Abdominal Ultrasound: Abdominal ultrasound is the primary diagnostic tool for confirming pyloric stenosis. Fluid and Electrolyte Management: Prior to surgery, infants with pyloric stenosis often require fluid resuscitation and correction of electrolyte imbalances caused by excessive vomiting. Intravenous hydration and electrolyte replacement may be necessary to restore the infant’s fluid and electrolyte balance. Atropine Therapy: In some cases, medical management with intravenous atropine may be attempted as a temporary measure to relieve pyloric spasm and improve the passage of food. Surgical management of pyloric stenosis involves performing a pyloromyotomy. This procedure is typically done under general anaesthesia and can be performed as an open surgery or laparoscopically. Postoperative Nursing Care: Monitor vital signs, surgical site, and signs of infection, such as fever, redness, swelling, or discharge. Administer prescribed pain medications and antibiotics. Observe for complications, such as bleeding or infection, and report any abnormalities to the healthcare team. Encourage early feeding and monitor for successful feeding tolerance, ensuring the infant is retaining and digesting food properly. Educate parents about postoperative care, including incision care, feeding techniques, and signs of potential complications, emphasizing the importance of follow-up visits and ongoing care.

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Introduction • Pyloric stenosis is also known as pylorostenosis or infantile hypertrophic pyloric stenosis. It is the most common cause of intestinal obstruction in infants. It is a form of obstruction in the gastric outlet which means a blockage from stomach to intestine. • It was First described by Hirschsprung in 1888 • Ramstedt described an operative procedure to alleviate the condition in 1907 – the procedure used to this day to treat pyloric stenosis. Definition • Hypertrophic pyloric stenosis is a marked and progressive outgrowth or enlargement of circular muscle fibers of pylorus causing partial or total obstruction of the stomach outlet due to narrowing of lumen. Anatomy The stomach sits in the upper abdomen on left side of the body. The top of the stomach connects to a valve called the esophageal sphincter (a muscle at the end of esophagus). The bottom of stomach connects to small intestine. The stomach is divided into 5 regions: • The cardia is the top part of the stomach. It contains the cardiac sphincter, which prevents food from traveling back up the esophagus. • The fundus is a rounded section next to the cardia. It's below the diaphragm (the dome-shaped muscle that helps to breathe). • The body (corpus) is the largest section of the stomach. In the body, stomach contracts and begins to mix food. • The antrum lies below the body. It holds food until the stomach is ready to send it to your small intestine. • The pylorus is the bottom part of the stomach. It includes the pyloric sphincter. This ring of tissue controls when and how stomach contents move to the small intestine. Incidence • It is more commonly seen in child with 2-5wks of age. • 2-9 per 1000 livebirths can be born with this condition. • Predominant sex: Male > Female (6:1). Males are more prone to get • Genetic predisposition can be an underlying factor for disease causation. • Full term babies especially first borne are most commonly affected. • Death from infantile hypertrophic pyloric stenosis is rare and unexpected; the reported mortality rate is very low and usually results from delays in diagnosis with eventual dehydration and shock. Etiology • Idiopathic • Other factors : *maternal stress especially in third trimester *elevated prostaglandin levels *deficiency of nitric acid *immature pyloric ganglion cells with abnormal muscle innervation. • In adults, it can occur due to history of peptic ulcer in pylorus region and hypertrophic changes in muscle layer of pylorus. Risk factors • Sex. Pyloric stenosis is seen more often in boys — especially firstborn children — than in girls. • Race. Pyloric stenosis is more common in whites of northern European ancestry, less common in Black people and rare in Asian

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