PYLORIC STENOSIS Pyloric stenosis is a medical condition in which the pylorus, the muscular valve between the stomach and the small intestine, becomes abnormally narrowed or obstructed, leading to the obstruction of the gastric outlet. This narrowing of the pylorus prevents the proper passage of food from the stomach to the small intestine. The exact cause of pyloric stenosis is still unknown, but it is believed to have a multifactorial etiology. Genetic factors are thought to play a role, as there is a higher incidence of pyloric stenosis among siblings and family members. Environmental factors may also contribute to the development of the condition, but specific triggers remain unidentified. The hallmark symptom of pyloric stenosis is projectile vomiting, which occurs shortly after feeding. Vomitus is often non-bilious and may resemble curdled milk. Forceful vomiting that may project several feet away from the infant. Signs of hunger and irritability despite frequent feeding attempts. Weight loss or poor weight gain. Dehydration and electrolyte imbalances due to excessive vomiting. Palpable “olive-shaped” mass in the epigastric region. Infants appear hungry, irritable, and unsatisfied after feeds. Physical Examination: Palpation of the abdomen may reveal a palpable “olive-shaped” mass in the epigastric region, which represents the hypertrophied pylorus. The “olive” can often be felt when the infant is in a relaxed state and the stomach is empty. Abdominal Ultrasound: Abdominal ultrasound is the primary diagnostic tool for confirming pyloric stenosis. Fluid and Electrolyte Management: Prior to surgery, infants with pyloric stenosis often require fluid resuscitation and correction of electrolyte imbalances caused by excessive vomiting. Intravenous hydration and electrolyte replacement may be necessary to restore the infant’s fluid and electrolyte balance. Atropine Therapy: In some cases, medical management with intravenous atropine may be attempted as a temporary measure to relieve pyloric spasm and improve the passage of food. Surgical management of pyloric stenosis involves performing a pyloromyotomy. This procedure is typically done under general anaesthesia and can be performed as an open surgery or laparoscopically. Postoperative Nursing Care: Monitor vital signs, surgical site, and signs of infection, such as fever, redness, swelling, or discharge. Administer prescribed pain medications and antibiotics. Observe for complications, such as bleeding or infection, and report any abnormalities to the healthcare team. Encourage early feeding and monitor for successful feeding tolerance, ensuring the infant is retaining and digesting food properly. Educate parents about postoperative care, including incision care, feeding techniques, and signs of potential complications, emphasizing the importance of follow-up visits and ongoing care.

1. PYLORIC STENOSIS
BY
PradeepAbothuM.Sc.,(N)
Associateprofessor
Dept of ChildHealthNursing

2. Definition
• Pyloric stenosis is a medical condition in which the pylorus, the
muscular valve between the stomach and the small intestine,
becomes abnormally narrowed or obstructed, leading to the
obstruction of the gastric outlet. This narrowing of the pylorus
prevents the proper passage of food from the stomach to the
small intestine.

3. Incidence
• Pyloric stenosis commonly occurs in infants,
usually within the first few weeks of life.
• It is more common in males than females, with a
male-to-female ratio of around 4:1.

4. ETIOLOGY
• The exact cause of pyloric stenosis is still unknown, but it is
believed to have a multifactorial etiology.
• Genetic factors are thought to play a role, as there is a higher
incidence of pyloric stenosis among siblings and family
members.
• Environmental factors may also contribute to the development
of the condition, but specific triggers remain unidentified.

5. • A diffuse hypertrophy and hyperplasia of smooth muscles of
pyloric sphincter
• Narrowing of pylorus with partial and then almost complete
obstruction
• Stomach contents can not flow easily through constricted
pylorus
PATHOPHYSIOLOGY

6. • In an attempt to push the food forward through the obstruction,
vigorous peristalsis occurs
• Persistent vomiting and dilated stomach musculature
• Infant develops dehydration and hypochloremic alkalosis

7. CLINICAL MANIFESTATIONS
• The hallmark symptom of
pyloric stenosis is projectile
vomiting, which occurs shortly
after feeding.
• Vomitus is often non-bilious
and may resemble curdled
milk.
• Forceful vomiting that may
project several feet away from
the infant.
• Signs of hunger and irritability
despite frequent feeding
attempts.

8. • Weight loss or poor weight gain.
• Dehydration and electrolyte imbalances due to excessive
vomiting.
• Palpable “olive-shaped” mass in the epigastric region.
• Infants appear hungry, irritable, and unsatisfied after feeds.

9. DIAGNOSTIC EVALUATIONS
Physical Examination:
• Palpation of the abdomen may
reveal a palpable “olive-shaped”
mass in the epigastric region, which
represents the hypertrophied
pylorus.
• The “olive” can often be felt when
the infant is in a relaxed state and
the stomach is empty.
Abdominal Ultrasound:
• Abdominal ultrasound is the primary
diagnostic tool for confirming
pyloric stenosis.

10. MEDICAL MANAGEMENT
Fluid and Electrolyte Management:
• Prior to surgery, infants with pyloric stenosis often require
fluid resuscitation and correction of electrolyte imbalances
caused by excessive vomiting.
• Intravenous hydration and electrolyte replacement may be
necessary to restore the infant’s fluid and electrolyte balance.
Atropine Therapy:
• In some cases, medical management with intravenous atropine
may be attempted as a temporary measure to relieve pyloric
spasm and improve the passage of food.

11. • However, surgical intervention remains the definitive
treatment for pyloric stenosis, and atropine therapy is
considered a temporary measure or a nonsurgical
alternative in certain cases.

12. SURGICAL MANAGEMENT
• Surgical management of pyloric stenosis involves performing
a pyloromyotomy.
• This procedure is typically done under general anaesthesia and
can be performed as an open surgery or laparoscopically.
• A small incision is made in the
hypertrophied pyloric muscle,
relieving the obstruction and creating
a wider pyloric channel. The goal is to
restore normal passage of food from
the stomach to the small intestine,
allowing for improved feeding and
resolution of symptoms.

13. NURSING
MANAGEMENT

14. Preoperative Nursing Care:
• Assess and monitor the infant’s vital signs, hydration status,
and electrolyte balance.
• Provide supportive care and comfort measures to alleviate
symptoms, such as frequent small feedings, burping, and
upright positioning after feeds.
• Educate parents about the condition, the upcoming surgical
procedure, and the expected postoperative care, addressing
any concerns or questions they may have.

15. • Postoperative Nursing Care:
• Monitor vital signs, surgical site, and signs of infection, such
as fever, redness, swelling, or discharge.
• Administer prescribed pain medications and antibiotics.
• Observe for complications, such as bleeding or infection, and
report any abnormalities to the healthcare team.
• Encourage early feeding and monitor for successful feeding
tolerance, ensuring the infant is retaining and digesting food
properly.
• Educate parents about postoperative care, including incision
care, feeding techniques, and signs of potential complications,
emphasizing the importance of follow-up visits and ongoing
care.

16. NURSING DIAGNOSIS
• 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
• Compromised family coping related to seriousness of illness
and impending surgery.