PYLORIC STENOSIS: Review the anatomy and physiology of digestive system Review the incidence of pyloric stenosis Define pyloric stenosis Explain the causes and risk factors of pyloric stenosis Describe the pathophysiology of pyloric stenosis Enumerate clinical features of pyloric stenosis Enlist the diagnostic evaluation for pyloric stenosis Explain the management of pyloric stenosis Enumerate the complications of pyloric stenosis

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2. PRESENTED BY:
Ann Joseph
M.Sc. Nursing 1 year
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4. OBJECTIVES
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 Review the anatomy and physiology of digestive
system
 Review the incidence of pyloric stenosis
 Define pyloric stenosis
 Explain the causes and risk factors of pyloric
stenosis
 Describe the pathophysiology of pyloric stenosis

5. OBJECTIVES CONT.
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 Enumerate clinical features of pyloric stenosis
 Enlist the diagnostic evaluation for pyloric stenosis
 Explain the management of pyloric stenosis
 Enumerate the complications of pyloric stenosis

6. ANATOMY
AND
PHYSIOLOGY
OF
STOMACH
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8. •3 in 1000 live birth
•Predominant in males (5:1)
•Commonly seen in first born male
child
•More commonly in child than the
adult.
INCIDENCE
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9. Pyloric stenosis is defined as
narrowing of the outlet of the
stomach so that food cannot
pass easily from it into the
duodenum, resulting in feeding
problem and projectile
vomiting.
DEFINITION
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10. RISK FACTORS
AND
ETIOLOGY OF
PYLORIC
STENOSIS
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11. Due to etiological factors
Marked hypertrophy and hyperplasia
of the circular and longitudinal
muscular layer of pylorus
PATHOPHYSIOLOGY
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13. Pyloric canal becomes
lengthened and thickened
Narrowing of gastric antrum
Impaired emptying of gastric
content
Projectile vomiting
PATHOPHYSIOLOGY
CONT.
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14. CLINICAL MANIFESTATION
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15. Projectile vomiting
CLINICAL
MANIFESTATION CONT.
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16. Constipation
CLINICAL MANIFESTATION
CONT.
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17. Weight loss
CLINICAL MANIFESTATION
CONT.
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18. Jaundice
CLINICAL
MANIFESTATION CONT.
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19. Persistent hunger
CLINICAL MANIFESTATION
CONT.
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20. Dehydration
CLINICAL MANIFESTATION
CONT.
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21. Epigastric distension
CLINICAL MANIFESTATION
CONT.
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22. Decreased urine output
CLINICAL MANIFESTATION
CONT.
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23. Palpable pyloric mass
CLINICAL MANIFESTATION
CONT.
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24. Stomach contraction
CLINICAL MANIFESTATION
CONT.
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25. DIAGNOSTIC EVALUATION
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26. DIAGNOSTIC EVALUATION
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 History collection
 Physical examination
 Abdominal USG
 Test for metabolic alkalosis(ABG)
 Urine analysis
 CBC

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28. X RAY OF ABDOMEN
CATERPILLAR SIGN
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29. MANAGEMENT
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30. •Symptomatic management
•Managing dehydration and electrolyte
imbalance
Pharmacological management
•Intravenous and oral atropine
MEDICAL MANAGEMENT
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31. SURGICAL MANAGEMENT
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32. Ramstedt’s pyloromyotomy
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33. Laproscopic pyloromyotomy
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34. NURSING MANAGEMENT
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35. Consider thermoregulation
Before transferring to OT,
transfer infant to incubator
Ensure incubator is pre warmed
for infant to be transferred into the
recovery
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36. NURSING MANAGEMENT
CONT.
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Monitor vitals hourly
Monitor wound and report
any abnormality
Observe for bleeding,
swelling, redness or ooze
from incision site

37. Maintain adequate fluid balance
Ensure adequate pain
relief.
NURSING MANAGEMENT
CONT.
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38. Fluid volume deficit related to frequent vomiting as
evidenced by dry skin and mucous membrane
Imbalanced nutrition less than body requirement
related to vomiting as evidenced by weight loss.
Impaired skin integrity related to surgery as evidenced
by observation
NURSING DIAGNOSIS :
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39. Anxiety of parents related to hospitalization and
surgery of child as evidenced by frequent questioning of
parents
Risk for injury related to postoperative complications
NURSING DIAGNOSIS
CONT.
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41. RESEARCH ARTICLE
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 Nitric oxide synthase activity in infantile
hypertrophic pyloric stenosis:
Marie J, Mailleux P, Schiffman S, Jacqueus J.
 A research was done to study pyloric tissue from 9
infants with infantile hypertrophic pyloric stenosis
and 7 as control infants.
 Result: Nicotinamiide adenine dinucleotide
phosphate diaphoresis activity was restricted to
enteric nervous system and blood vessel.

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 In the pyloric tissue from the control patient
intense diaphorase activity was seen, whereas in
pyloric tissues of patient with infantile
hypertrophic pyloric stenosis there was no
diaphorase activity.
 Conclusion: study suggested that a lack of nitric
oxide synthase in pyloric tissue is responsible for
pyloro-spasm in infantile hypertrophic pyloric
stenosis.

43. RECAPITULATION
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 Define pyloric stenosis?
 Explain the causes and risk factors of pyloric stenosis?
 Describe the pathophysiology of pyloric stenosis?
 Enumerate clinical features of pyloric stenosis?
 Enlist the diagnostic evaluation for pyloric stenosis?
 Explain the management of pyloric stenosis?
 Enumerate the complications of pyloric stenosis?

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45. DOUBT..????
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46. ASSIGNMENT
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 Write an assignment on nursing management of pyloric
stenosis including pre and postoperative management.
 Date of submission: 13/5/19
 Time of submission: Before 4 pm
 Place of submission: I yr M.Sc (N) classroom
 Total Marks: 10
 Criteria for evaluation.
 Content :8 marks
 Neatness: 2 mark

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 Williams and Wilkins. Lippincott manual of nursing
practice, 10 edition. Wolter kluwer publication. New
delhi:2013
 Lawrence J. Brandt. Clinical practice of gastroenterology.
Volume 2. current medicine Inc. Publication. USA:1999
 A Parthasarathy. IAP textbook of paediatrics. 6 edition.
Jaypee publication. New Delhi.
 Forfar, Arneil. Forfar and arneil’s textbook of paediatrics.
Churchill publication:2008
 Ignatanicious, Workman. Medical surgical nursing patient
centered collaborative care. 7 edition. Elsevier publication.
USA:2007
 S N Chungh. Textbook of medicine for MBBS. 2 edition.
India: Arya publication:2013
 Vanderwinder J, Pierre MD, Schiffman SN. Nitric oxide
synthase activity in infantile htpertrophic pyloric stenosis. N
Enge J med 1992; 237:511-5. Available from: DOI:
10.1056/NEJM19920820327082

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