Pyloric stenosis is a narrowing of the pylorus, the valve between the stomach and small intestine, causing projectile vomiting after feeding. It most commonly affects young male infants and is treated with surgery to widen the pylorus. Nursing care involves correcting dehydration pre-operatively through IV fluids and monitoring for complications like infection or persistent vomiting post-operatively.

1. Pyloric stenosis
Mrs. Nibi mol baby
Associate professor

2. OVERVIEW
▪ The pylorus is a muscular valve located between the stomach
and the small intestine.
▪ It’s the exit point of the stomach and the gateway to the
duodenum of the small intestine.
▪ It helps the stomach hold food, liquids, acids, and other matter
until they are ready to move on to the small intestine and be
further digested and then absorbed.
▪ For reasons that aren’t entirely understood, the pylorus can
sometimes thicken and cause luminal narrowing. This is called
pyloric stenosis.

3. DEFINITION
▪ Pyloric stenosis is defined as “narrowing (stenosis) of the outlet of
the stomach so that food cannot pass easily from it into the
duodenum, pyloric stenosis results in feeding problems and projectile
vomiting.
▪ Narrowing (stenosis) of the opening from the stomach to the first
part of the small bowel (duodenum), due to enlargement
(hypertrophy) of the pylorus.

4. INCIDENCE/RISK FACTORS
• Sex. Male babies, especially first-born males, are more at risk than
females.
• Family history. Roughly 15 percent of babies with the condition have
a family history of the disorder. A baby born to a woman who had the
condition as an infant is three times more likely to have pyloric
stenosis.
• Race.The condition is most likely to affect Caucasians of Northern
European descent. It’s less common in African-Americans and Asians.
• Smoking tobacco. Smoking during pregnancy almost doubles the
chance of giving birth to a baby with pyloric stenosis.

5. CONT…
• Bottle feeding. In a 2012 studyTrusted Source, infants who were
bottle fed had a higher risk for pyloric stenosis, being at least four
times as likely to develop the condition than those who weren’t
bottle fed. Experts in this study could not determine exactly if the
higher risk was because of the feeding mechanism itself, or if breast
milk versus formula during the feedings also contributed to the
increased risk.
• Antibiotic use.The use of certain antibiotics early in life can increase
a baby’s risk of pyloric stenosis. One study suggests that infants given
antibiotics in the first two weeks of life had the greatest risk.
▪

8. CLINICAL FEATURES
• 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. may notice wavelike contractions
(peristalsis) that ripple across baby's upper abdomen soon after
feeding but before vomiting. This is caused by stomach muscles
trying to force food through the narrowed pylorus.

9. CONT……
• Dehydration. baby might cry without tears or become lethargic.
might find 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.

10. DIAGNOSTIC EVALUATION
▪ PHYSICAL EAMINATION
▪ EVERLY MALNURISHED INFANTS
▪ BARIUM MEAL X-RAY
▪ USG
▪ BLOOD IVESTIGATION

11. Medical management
▪ Infantile pyloric stenosis is typically managed with surgery; very few
cases are mild enough to be treated medically.
▪ The danger of pyloric stenosis comes from the dehydration and
electrolyte disturbance rather than the underlying problem itself.
▪ Therefore, the baby must be initially stabilized by correcting the
dehydration and the abnormally high blood pH seen in combination
with low chloride levels with IV fluids.This can usually be
accomplished in about 24– 48 hours

12. CONT…
▪ Intravenous and oral atropine may be used to treat pyloric stenosis. It
has a success rate of 85-89% compared to nearly 100% for
pyloromyotomy, however it requires prolonged hospitalization,
skilled nursing and careful follow up during treatment.
▪ it might be an alternative to surgery in children who have
contraindications for anesthesia or surgery, or in children whose
parents do not want surgery.

13. SURGICAL MANAGEMENT
▪ Laparoscopic pyloromyotomy.
▪ Fred-Ramstedt’s Pyloromyotomy

15. NURSING MANAGEMENT
▪ Preoperative management
▪ observe and record vital signs of the infant as they help in detecting and
proven electrolyte imbalance.
▪ note and record the amount and characteristics of monitors and stool .
▪ stop order feeding and administrate intravenous fluid as prescribed
▪ is Olivia allowed then feed the infant in semi upright position . Feed slowly
and BURP frequently to prevent vomiting.
▪ After saving make the infant lie and head end of the bed is elevated to
promote gastric and empty. place the baby in the right sideline on prone
position.

16. Continue
▪ Give small frequent feeds.
▪ weigh the infant daily, in order to determine the degree of
dehydration.
▪ Maintain strict intake and output chart.
▪ Provide warmth to the infant and protect from infection.
▪ prior to surgery gastric lavage is done with isotonic normal saline .
▪ fluid and electrolyte losses must be corrected, 24 to 48 hours before
surgery .

17. Post operative nursing care.
▪ First 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. Nursing diagnosis
▪ fluid volume deficit belated to frequent vomiting as evidenced by dry
skin and mucous membrane.
▪ imbalanced nutrition less than body requirement related to vomiting
as evidenced by weight loss.
▪ impaired skin integrity related to surgery as evidenced by
observation.
▪ anxiety of parents related to hospitalisation and surgery of child as
evidenced by frequent questioning of parents.
▪ risk for injury related to post operative complication