unlearn, relearn and learn

1. “CONGENITAL
HYPERTROPHIC
PYLORIC
STENOSIS”
S. Gracelet Melita
2nd year M.Sc(N)

2. INTRODUCTION:
– The pylorus meaning “gate”
– It is the most common intra abdominal condition
during the neonatal period, which requires
surgery.

3. DEFINITION:
– Pyloric stenosis is defined as, “narrowing &
obstruction of the lower portion of stomach that
prevents food from moving from the stomach to
the intestine
– It is caused due to hypertrophy and hyperplasia of
circular muscles of stomach.

4. INCIDENCE:
– 3/1000 live births
– Male: female = 4: 1
– Commonly seen in 1st born male child
– Age: 3weeks to 3 months
– Child > adult

5. ETIOLOGY AND RISK
FACTORS:
– Idiopathic
– Nitric oxide syntheses deficiency
– Nerve cell theory( ganglion cell theory)
– Premature birth
– Family history( 20% of male descendent, 10% of female
descendent)
– Race( common – northern European Ancestory; less common in
African and American; rare in Asians)
– Sex( male> female)
– Early antibiotic use( erythromycin)

6. PATHOPHYSIOLOGY:

8. CLINICAL FEATURES:
– Symptoms usually appear between 2- 4 weeks of age
– Initially;
– Regurgitation, non bilious vomiting both during and
after feeding
– Forceful and projectile vomiting
– Vomitus contains mucous, streaks of blood, no bile.
– Always seems to hungry

10. OTHER SYMPTOMS:
– Weight loss
– Dehydration
– Fewer bowel movements
– Reduced frequency and amount of stool

11. DIAGNOSTIC EVALUATION:
– Physical examination( olive sized mass)
– Epigastric distension
– Confirmatory diagnosis;
– Barium study of upper GI tract
– Blood investigations
– Urine specific gravity

13. MANAGEMENT:
SURGICAL MANAGEMENT:
– 2 stages;
– Initially IV fluids
– Pyloromyotomy or Fredet - Ramstedt

15. NURSING MANAGEMENT:
– PRE OP NURSING CARE;
– Vital signs
– Note and record the amount and
characteristic of vomitus
– IV fluids
– Positioning during and after feeds
– Small frequent meals

16. – Weigh the child daily
– I/O chart
– Provide warmth
– Gastric lavage prior to surgery
– Correction of fluid and electrolytes

17. POST OP NURSING CARE:
– Observe for signs of complications
– Management of pain
– Provision of adequate fluid and nutrition
– Parental education and follow up after surgery

18. COMPLICATIONS:
– Wound infection
– Incisional hernia
– Persistent vomiting
– Stagnation gastritis
– Mucosal perforation
– shock

19. PROGNOSIS:
– Excellent if identifies and treated early
– Mostly they recover without any complications

20. JOURNAL INFORMATION:
– Efficacy of medical treatment for infantile
hypertrophic pyloric stenosis.
– Comparison of the curative effect between
laparotomy and laparoscopic pyloromyotomy in
the treatment of congenital hypertrophic pyloric
stenosis

21. ASSIGNMENT:
– Refer more journals on congenital hypertrophic
pyloric stenosis.

22. REFERENCE:
- “Kyle terri, Carmen susan,essential of
paediatric nursing, 3rd edition, wolters
kluwer publication”
- “Swarna rekha bhat, (2009), Achars
textbook of paediatrics, 4th edition,
university pren india pvt limited, ”
- “Ball jane, bindler ruth, principles of
paediatric nursing, 5th edition, pearson
publication”
- “Singh meharban, essential paediatric for
nurses, 3rd edition, CBS publishers, page-”
- “Scott Julius, scott’s paedia tricks,
(2011), 3rd edition, paras medical books
publishers”

23. - “Sharma rimple, essential of paediatric nursing,
(2017), 2nd edition, jaypee publication”
- “Paul k vinod, baggar aravind, essential
paediatrics, 2013, 8th edition, CBS publishers”
- “piyush gupa, (2017), essential paediatric
nursing, 4th edition, CBS publishers, page-”
- “Wong’s, nursing care of infants and children,
10th edition, Elsevier publication, page-”
- “ Datta Parul, (2009), padiatric nursing, 2nd
edition, jaypee Brothers medical publishers”