It occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The patient has nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

1. Pyloric stenosis
DR.ESWARAPPA S
PROFESSOR
SHRIDEVI COLLEGE OF NURSING
TUMKUR

2. Pyloric Obstruction
• Pyloric obstruction, also called gastric outlet
obstruction (GOO),occurs when the area distal
to the pyloric sphincter becomes scarred and
stenosed from spasm or edema or from scar
tissue that forms when an ulcer alternately
heals and breaks down. The patient has
nausea and vomiting, constipation, epigastric
fullness, anorexia, and, later, weight loss.

3. DEFINITION
Pyloric stenosis is defined as narrowing of the
outlet of the stomach so that food can not pass
easily from it into the duodenum resulting in
feeding problems and projectile vomiting .
-- Pyloric stenosis or pylorostenosis is narrowing
(Stenosis )of the opening from the stomach to the
first part of the samll intestine known as the
duodenum.
Pylorus meaning gate

4. Pyloric Stenosis
• Pyloric Stenosis is characterized by
hypertrophy of the circular muscle fibers of
the pylorus, with a severe narrowing of the
lumen.
• The pylorus is thickened to as much as twice
its size, is elongated, and has a consistency
resembling cartilage; as a result of this
obstruction at the distal end of the stomach,
the stomach becomes dilated.

5. Pyloric stenosis

6. Causes of pyloric stenosis
Nitric oxide. Impairment of this neuronal nitric
oxide synthase (nNOS) synthesis has been
implicated in infantile hypertrophic pyloric
stenosis, in addition to Achalasia, (absent or
ineffective peristalsis) (wavelike contraction)
• Diabetic gastroparesis- component of
autonomic neuropathy resulting from type-
1and type -2

7. Causes of pyloric stenosis
Genetic factors. A nationwide study of nearly 2
million Danish children born between 1977 and
2008 shows strong evidence for familial
aggregation and heritability of pyloric stenosis.
Exposure to antibiotics. A cohort study found that
treatment of young infants with macrolide
antibiotics was strongly associated with infantile
hypertrophic pyloric stenosis (IHPS).
Premature birth
In adult it can occur due to h/o peptic ulcer in
pylorus region and hypertrophic changes in
muscle layer of pylorus

8. RISK FACTORS FOR PYLORIC STENOSIS
• Smoking during pregnancy. This behavior can nearly
double the risk of pyloric stenosis.
• Early antibiotic use. Babies given certain antibiotics in the
first weeks of life — erythromycin to treat whooping
cough, for example — have an increased risk of pyloric
stenosis. In addition, babies born to mothers who took
certain antibiotics in late pregnancy may have an increased
risk of pyloric stenosis.
• Bottle-feeding. Some studies suggest that bottle-feeding
rather than breast-feeding can increase the risk of pyloric
stenosis. Most of the people who participated in these
studies used formula rather than breast milk, so it isn't
clear whether the increased risk is related to formula or
the mechanism of bottle-feeding.

10. Signs&Symptoms
• Vomiting after feeding. The baby may vomit forcefully, ejecting breast
milk or formula up to several feet away (projectile vomiting). Vomiting
might be mild at first and gradually become more severe as the pylorus
opening narrows. The vomit may sometimes contain blood.
• Persistent hunger. Babies who have pyloric stenosis often want to eat
soon after vomiting.
• Stomach contractions. You may notice wavelike contractions
(peristalsis) that ripple across your baby's upper abdomen soon after
feeding but before vomiting. This is caused by stomach muscles trying
to force food through the narrowed pylorus.
• Dehydration. Your baby might cry without tears or become lethargic.
You might find yourself changing fewer wet diapers or diapers that
aren't as wet as you expect.
• Changes in bowel movements. Since pyloric stenosis prevents food
from reaching the intestines, babies with this condition might be
constipated.
• Weight problems. Pyloric stenosis can keep a baby from gaining
weight, and sometimes can cause weight loss.

11. Pathophysiology
DUE TO ETIOLOGICAL FACTORS
MARKED HYPERTROPHY AND HYPERPLASIA OF
THE CIRCULAR AND LONGITUDINAL
MUSCULAR LAYER OF PYLORUS
NORMAL CELLS BECAME A HYPERTROPHY ANF
HYPERPLASIA

12. PATHOPHYSIOLOGY
PYLORIC CANAL BECOMES LENGTHENED AND
THICKENED
NARROWING OF GASTRIC ANTRUM
IMPAIRED EMPTYING OF GASTRIC CONTENT
PROJECTILE VOMITING

13. PYLORIC STENOSIS

14. Diagnosis
• Blood tests to check for dehydration or
electrolyte imbalance or both
• Ultrasound to view the pylorus and confirm a
diagnosis of pyloric stenosis
• X-rays of your baby's digestive system, if
results of the ultrasound aren't clear More
Information
• Ultrasound
• X-ray

15. SURGICAL INTERVENTION
In pyloromyotomy, the surgeon cuts only
through the outside layer of the thickened
pylorus muscle, allowing the inner lining to
bulge out. This opens a channel for food to
pass through to the small intestine.

16. Medical management
Treatment. The first form of treatment for
pyloric stenosis is to identify and correct any
changes in body chemistry using blood tests
and intravenous fluids.
Correction of electrolytes
Pyloric stenosis is always treated with surgery,
which almost always cures the condition
permanently.

17. After surgery
• Your baby might be given intravenous fluids
for a few hours. You can start feeding your
baby again within 12 to 24 hours.
• Your baby might want to feed more often.
• Some vomiting may continue for a few days.

18. Nursing Interventions
Nursing interventions include monitoring vital
signs, airway patency, and neurologic status;
managing pain; assessing the surgical site;
assessing and maintaining fluid and electrolyte
balance; and providing a thorough report of the
patient's status to the receiving nurse on the unit,
as well as the patient's family.
Maintain adequate nutrition and fluid intake.
Provide mouth care.
Promote family coping.