Pyloric stenosis is a condition in infants where the pyloric sphincter becomes narrowed due to thickening of the muscle, obstructing food passage from the stomach. It typically occurs in males under 6 months, presenting with projectile vomiting. Diagnosis involves abdominal imaging and treatment is pyloromyotomy surgery to divide the thickened muscle. Post-op care focuses on resuming feeding and monitoring for dehydration or wound issues.

1. Pyloric stenosis
Introduction
Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is the most
common cause of intestinal obstruction in infancy. Pyloric stenosis is the condition in which
there is narrowing of the pyloric sphincter due to hypertrophy of the circumferential muscle
of the pyloric sphincter resulting in obstruction of the gastric outlet. 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. The condition usually develops in the
first few weeks of life (2nd week to 2nd month)
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.
Pyloric stenosis is narrowing (stenosis) of the opening from the stomach to the first part of
the small intestine known as the duodenum
Incidence:
Sex: the condition is more common (five times) in first born full term male child.
Age:-common during infancy; two to three out of 1000 infants are affected by pyloric
stenosis.
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)
Source:- https://realmedicinefoundation.org/wp-
content/uploads/2019/09/RMF_Nepal___Kanti_Children_s_Hospital___Q4_2018.pdf
Etiology
a. The exact etiology is unknown.
b. Inherited- several members of a family have had this problem in infancy(first degree
relatives)
c. Monozyotic twins
d. Congential (previously it was thought to be a congenital problem).
e. The infant born with parent having IHPS has more risk than infants born with normal
parents.
f. Smoking during pregnancy: This behavior can nearly double the risk of pyloric
stenosis.
g. Early antibiotic use: Babies given certain antibiotics in the first weeks of life -
erythromycin to treat whooping cough, for example - have an increased risk of pyloric
stenosis In addition, babies born to mothers who took certain antibiotics in late
pregnancy may have an increased risk of pyloric stenosis.
h. Premature birth. Pyloric stenosis is more common in babies born prematurely than in
full-term babies.
i. Bottle-feeding. Some studies suggest that bottle-feeding rather than breast-feeding can
increase the risk of pyloric stenosis. Most of the people who participated in these
studies used formula rather than breast milk, so it isn't clear whether the increased risk
is related to formula or the mechanism of bottle-feeding.

2. Pathophysiology
Hypertrophy and hyperplasia of circular muscle
Severe narrowing of the pyloric canal
Partial obstruction of gastric outlet
Further inflammation and edema
Further reduction of opening
Complete obstruction
Clinical Manifestation
Clinical Features
The newborn is asympomatic in the first weeks after birth. Symptoms develop usually in 2nd
week in of the life. Common symptoms are;
 Vomiting: Projectile type vomiting occurs after breastfeeding weeks. Newborn
increases looks frequency and vomiting becomes and eager projectile to breast(1
2weeks). Newborn looks well after vomiting and eager to breast feed ag.ain
 Presence of upper abdominal distension
 Palpable olive shaped mass is found in epigastrium just to the right of the umbilicus
 Gastric peristaltic waves is visible moving from left to right across the epigastrium
 Decreased frequency and volume of stool
 Sign of dehydration and electrolyte imbalance.
 The newborn has weight loss, failure to thrive
Diagnosis Procedure
 Complete history and physical examination to find out presentation of infant. And
child's presentation
 Abdominal X-ray, Ultrasonography (USG) of upper GI tract
 Barium swallow/ upper gastro intestinal series- a diagnostic test
 Serum electrolyte (sodium, potassium) level, hemloglobin level
Management
General management of newborns includes management of hydration and nutrition level
with IV fluid and preventing the aspiration

3. a. Obtain IV access and 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.
b. 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 by dividing
the muscle of the pylorus to open the gastric outlet.
c. Gastric lavage with isotonic saline
d. Antibiotic therapy.
Nursing Management
Assessment
Assess the child’s history of vomiting. Ask when the vomiting started and determine the
character of the vomiting.
Assess for the child’s elimination. Ask the caregiver about constipation and scanty urine.
Physical exam:- Physical exam reveals an infant who may show signs of dehydration; obtain
the infant’s weight and observe skin turgor and skin condition, anterior fontanelle,
temperature, apical pulse rate, irritability, lethargy, urine, lips and mucous membranes of the
mouth, and eyes; observe for visible gastric peristalsis when the infant is eating.
Nursing Diagnoses
Based on the assessment data, the major nursing diagnoses are:
 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.
Nursing interventions are:
 Maintain adequate nutrition and fluid intake.
(i) If the infant is severely dehydrated and malnourished, rehydration with
intravenous fluid and electrolytes is necessary;
(ii) Feedings of formula thickened with infant cereal and fed through a large-holed
nipple may be given to improve nutrition;
(iii)Feed the infant slowly while he or she is sitting in an infant seat or being held
upright.

4.  Provide mouth care. The infant needs good mouth care as the mucous
membranes of the mouth may be dry because of dehydration and omission of oral
fluids before surgery; a pacifier can satisfy the baby’s need for sucking because of
the interruption in normal feeding and sucking habits.
 Promote skin integrity.
(i) Repositioned the infant two hourly ,
(ii) Timely change the diaper
(iii) Provide childe cream or ointment is applied to dry skin areas.
 Promote family coping.
a. Include the caregivers in the preparation for surgery and explain the importance of
added IV fluids,
b. Provide information of ultrasonographic or barium swallow examination,
c. Provide information of the function of the NG tube and saline lavage;
d. Describe the surgical procedure to be performed;
e. Explain what to expect and how long the operation will last.
Preoperative Care
 Monitor vital signs, intake output, general condition
 Keep infant NPO, nasogastric tube drainage
 Assess the amount, character and frequency of vomiting
 Prepare for the surgical procedure
 Prevent removal of intravenous and nasogastric tube.
 Consent for surgery and other preparation for surgery
 Reassurance and support to parents
 Provide preoperative medications
 Ensure adequate nutrition and hydration level of the infant/child before and after
surgery
 Maintain warmth, take daily weight
 Maintain general hygiene-stool, urine care
 Prepare the child and the parents for different procedures and treatment
 Preoperative care like collection of lab report consent
 Promote adequate hydration and nutrition by administering parenteral fluids and
electrolyte as prescribed.
 To prevent aspiration
1. Feed the infant slowly,
2. Perform burping after feeding,
3. Position the infant in the high fowler position on the right side after feeding.
Post-operative care
 Keep the baby comfortable in the bed
 Assess vital sign and general condition of baby

5.  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
 Maintain warmth and proper ventilation of the room
 Time to time assess wound site, vital signs and other general condition after surgery
 Promote comfort with analgesic, cuddling, holding by parents
 Care of operation site consist of observation of incision site for bleeding, drainage,
inflammation and care of the incision site
 Start feeding 4-6 hours after surgery with clear fluid. If tolerated, advance to breast
milk usually after 24 hours.
 Maintain warmth, take daily weight
 Maintain general hygiene-stool, urine care
 Reposition two hourly.
 Encourage the parents to remain with their child, involve in their child care.
 Support and reassurance of the parents.
 Discharge after 48 hours after achievement of feeding regimen
 Provide instruction about home care like frequent feeding positioning, burping after
feeding
 Provide instruction about wound care follow up care as well as other well baby care.
Complications
Pyloric stenosis can lead to:
(i) Failure to grow and develop.
(ii) Dehydration. Frequent vomiting can cause dehydration and a mineral (electrolyte)
imbalance. Electrolytes help regulate many vital functions.
(iii)Stomach irritation. Repeated vomiting can irritate your baby's stomach and may
cause mild bleeding.
(iv)Jaundice. Rarely, a substance secreted by the liver (bilirubin) can build up, causing a
yellowish discoloration of the skin and eyes
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/

6.  https://www.mayoclinic.org/diseases-conditions/pyloric-stenosis/symptoms-
causes/syc-20351416