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1. Presented by:-
Sushmita Bajagain

3. Content
Pyloric Stenosis
1. Introduction
2. Incidence, Etiology
3. Pathophysiology
4. Clinical feature, diagnosis
5. Management ,nursing management
6. Complication

4. Pyloric stenosis
Introduction
 Pyloric stenosis is also known as infantile hypertrophic
pyloric stenosis (IHPS), is the most common cause of
intestinal obstruction in infancy.
 The infant with pyloric stenosis are clinically normal
at birth, and subsequently develop non-bilious
projectile vomiting during the first few weeks of
postnatal life.

5. Definition
 Pyloric stenosis is a condition of narrowing of the
pyloric sphincter due to progressive overgrowth or
enlargement of circular muscle fibres of pylorus
resulting partial or complete obstruction of the gastric
outlet.

6. Incidence:
 Kanti Children's hospitals have served a total of 103
patients in the Surgical ICU of Kanti Children’s
Hospital, from October to December 2018.
 Infantile hypertrophic pyloric stenosis 5 (October),
2(November), 3(December)

7. Etiology
 Unknown.
 The infant born with parent having IHPS has more
risk.
 Smoking during pregnancy
 Early antibiotic use
 Premature birth.
 Bottle-feeding

8. Pathophysiology
Hypertrophy and hyperplasia of circular muscle
Severe narrowing of the pyloric canal
Partial obstruction of gastric outlet

9. Pathophysiology
Further inflammation and edema
Further reduction of opening
Complete obstruction
Clinical Manifestation

10. Clinical Features
 Asympomatic in the first weeks after birth.
 Symptoms develop usually in 2nd week in of the life.
Common symptoms are;
 Gastric peristaltic waves is visible moving from left to
right across the epigastrium

11. Clinical feature
 Vomiting
 Palpable olive shaped mass

12. Clinical features…
 Presence of upper abdominal distension
 Decreased frequency and volume of stool
 Sign of dehydration and electrolyte imbalance.

14. Management
General management of newborns includes
 Management of hydration
 Preventing the aspiration

15. Management
 Give an IV bolus of 20ml/kg of normal saline.
 Then give 5% dextrose with1/2 normal saline of 15
ml/kg maintenance volume.
 Correct fluid and electrolyte imbalance over 24-48
hours.
 Establish a good urine output>1ml/kg/hour and then
add potassium and chloride to the IV fluids as
prescribed.

16. Surgery
 Pyloromyotomy is performed under anaesthesia at age
of 4-5 weeks. In this surgical procedure, tight pyloric
muscle is repaired by dividing the muscle of the
pylorus to open the gastric outlet.

17. Management
 Gastric lavage with isotonic saline

18. Nursing Management
Assessment
 Assess the child’s history of vomiting.
 Assess for the child’s elimination ,constipation
 Assess the sign of dehydration ,and observe for visible
gastric peristalsis movement.

19. Nursing Diagnoses
 Imbalanced nutrition: less than body
requirements related to inability to retain food.
 Deficient fluid volume related to frequent vomiting.
 Impaired oral mucous membrane related to NPO
status.
 Risk for impaired skin integrity related to fluid and
nutritional deficit.

20. Nursing interventions
Maintain adequate nutrition and fluid intake.
 If the infant is severely dehydrated and malnourished.
 Rehydration with intravenous fluid and electrolytes is
necessary.
 Feed the infant slowly while he or she is sitting in an
infant seat or being held upright.

21. Nursing intervention
Promote skin integrity.
 Repositioned the infant two hourly.
 Timely change the diaper .
 Provide cream or ointment is applied to dry skin areas.

22. Preoperative Care
 Monitor vital signs, intake output, general condition
 Keep infant NPO, nasogastric tube drainage, consent
for surgery , collection of lab report.
 Assess the amount, character and frequency of
vomiting
 Prevent removal of intravenous and nasogastric tube.

23. Preoperative care
 Provide preoperative medications
 Ensure adequate nutrition and hydration level of the
infant/child before and after surgery
 Prepare the child and the parents for different
procedures and treatment

24. Post-operative care
 Keep the baby comfortable in the bed
 Assess vital sign and general condition of baby
 Assess the wound for soakage and bleeding after
surgery
 Maintain the hydration level by providing the iv fluid
as indicated
 Assess the level of pain

25. Post operative care
 Maintain warmth and proper ventilation of the room
 Encourage the parents to remain with their child,
involve in their child care.
 Start feeding 4-6 hours after surgery with clear fluid. If
tolerated, advance to breast milk usually after 24
hours.

26. Complications
 Dehydration.
 Stomach irritation.
 Jaundice.

28. Reference of pyloric stenosis
 Uprety K, Child Health Nursing, fourth Edition (2071 Bhadra),
Tara Books and Stationery, Chhetrapati, Kathmandu, pg 136- 137
 Shrestha T. Essential Child Health Nursing. first Edition
2015,August. Medhavi Publication; Jamal, Kathmandu Page
no.270-273
 WilsonD, Rodgers CC, Hockenberry M, Wongs Essential of
pediatric Nursing 10 th edition, ELSEVIER, page no 1418-1416
 Adhikari T, Essential of Pediatric Nursing, first 2014 edition,
vidyarthi pustak bhadar, bhotahity, Kathmandu, page no167-171
 https://www.uptodate.com/contents/infantile-
hypertrophic-pyloric-stenosis
 https://nurseslabs.com/pyloric-stenosis/
 https://www.mayoclinic.org/diseases-conditions/pyloric-
stenosis/symptoms-causes/syc-20351416