This document discusses infantile hypertrophic pyloric stenosis (IHPS), a condition where the pyloric muscle of the stomach becomes thickened, preventing food from passing normally into the small intestine. The key points are:
- IHPS is most common in firstborn males under 6 weeks of age and may be linked to erythromycin use as an infant.
- Symptoms include projectile vomiting, dehydration, and weight loss. Diagnosis involves feeling an olive-sized lump in the stomach and confirming on ultrasound or blood tests.
- Treatment involves rehydration followed by pyloromyotomy surgery to cut the thickened muscle and allow food to pass through. Complications
2.
Hypertrophy of musculature of pyloric antrum,
especially the circular muscle fibres
Failure of pylorus to relax.
Gastric outlet obstruction
Duodenum is normal.
Increased risk if newborn gets erythromycin or
azithromycin in first 14 days after birth.
INFANTILE HYPERTROPHIC
PYLORIC STENOSIS
4.
It is postulated that abnormal innervation of the
muscular layer leads to failure of relaxation of the
pyloric muscle, increased synthesis of growth
factors, and subsequent hypertrophy, hyperplasia,
and obstruction.
Erythromycin has a prokinetic effect on gastric
muscle contraction.
ETIOLOGY
5.
Common in first born males(4:1)
Incidence: 4 in 1000 live births
Familial link found.
Seen between 3rd and 6th weeks of age , time taken by
the hypertrophied muscle to cause complete
obstruction
CLINICAL FEATURES
6.
Vomiting – forcible, projectile and non-bilious,
may occur after every feed or only after some feed.
Despite stomach distension, affected infants seem to
have an insatiable appetite and may cry
inconsolably.
Constipation
Dehydration
Loss of weight
SYMPTOMS
8.
Visible gastric peristalsis
Palpable lump of hypertrophied pylorus , better felt
from left side, as a mobile, smooth, firm, olive like
mass , with all borders made out, moves with
respiration, with impaired resonance on percussion.
Electrolyte imbalance(hyponatremic, hypokalemic,
metabolic alkalosis with paradoxic aciduria)
SIGNS
9.
VGP and mass is better seen and felt
Vomiting is regurgitant
Anorexia common
In premature infants,
10.
Biochemical assessment(pH>7.45, Cl- 3mEq/L)
X ray Abdomen
USG- doughnut sign,
pylorus > 4 mm thickness,(normal<2mm)
pyloric canal > 14 mm,(normal<10mm)
cervix sign on long axis,
target sign on short axis.
INVESTIGATIONS
15.
Correction of dehydration and electrolyte imbalance.
Intravenous fluid therapy is begun with 0.45–0.9%
saline, in 5–10% dextrose, with the addition of
potassium chloride in concentrations of 30–
50mEq/L until the infant is rehydrated and the
serum bicarbonate concentration is less than
30mEq/dL, which implies that the alkalosis has been
corrected.
Most infants can be rehydrated within 24 hours
TREATMENT
16.
Surgery –
1. Ramstedt’s operation- After laparotomy,
hypertrophied muscle is cut out along the whole
length adequately until mucosa bulges out.
Muscosa not opened.
2. Laparoscopic pyloromyotomy
Oral feeds reintroduced in 8-12 hrs, post-op vomiting
resolves in 24 hrs.