Hypertrophic pyloric stenosis occurs when the pyloric sphincter muscle thickens, narrowing the stomach outlet. It typically affects young infants, especially firstborn males. Projectile vomiting after feeding is the main symptom. Diagnosis involves abdominal x-ray or ultrasound showing thickening of the pylorus. Surgical pyloromyotomy is the standard treatment and relieves the obstruction by cutting the thickened muscle. Nursing care focuses on maintaining nutrition, hydration and family support until surgery can be performed.

1. Hypertrophic Pyloric
Stenosis
Ms. K. Lavanya
MSc(N)-CHN
Associate Professor

2. Definition:
• Pyloric Stenosis is not a congenital Disorder.
• Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric
sphincter becomes thickened, resulting in elongation and narrowing of the pyloric
channel and leads to partial or total obstruction of the stomach outlet.

3. Incidence
First born children and males are
affected 5 times more frequently than
females.

4. Etiology:
 Idiopathic
 Maternal stress in last trimester
 Elevated prostaglandin level
 Deficiency of nitric acid
 Immature pyloric ganglionic cells with abnormal muscle
interventions.
 Primarily argyrophilic nitrergic neurons are affected

5. Pathophysiology:

6. Clinical Manifestations:
 Projectile Vomiting
 May be ejected 3-4 feet from the child when in a side lying position, 1feet or more when in a
back lying position.
 Occurs shortly after a feeding
 May follow each feeding or appear intermittently
 Nonbilious vomitus
 May be blood tinged
 Infant Hungry- Eagerly accepts the second feeding after vomiting episode
 No evidence of pain or discomfort
 Weight loss
 Signs of dehydration
 Distended upper abdomen
 Olive like mass on the right upper quadrant of the abdomen
 Visible gastric peristaltic waves that move from left to right across the
epigastrium.

7. Diagnostic Evaluation:
 HC
 PE
 Abdominal X-ray
 Barium Meal X-ray- Elongated pyloric canal (string sign) or thickened pyloric mucosa (double
track sign)
 USG
 Decreased serum levels of both sodium and potassium
 Decreased in serum chloride level and increases in pH and bicarbonate
 Increased BUN level
 Urine examination
 Blood examination for Hb%.

8. Management:
 Fredet- Ramstedt procedure (Pyloromyotomy) – Longitudinal incision on
the pylorus thus relieves gastric outlet obstruction.
 Laproscopy
 Endoscopic balloon dilatation
Complications:
• Gastro esophageal reflux

9. Nursing Considerations:
 Weight on admission, recorded as baseline
 Blood pressure (at least a baseline recording)
 2 Hourly Aspiration of NGT
 4 Hourly observations (or as clinical needs dictate)
 Temperature
 Heart rate
 Respiratory rate
 6 hourly monitoring of blood sugar while on IV fluids
 The patient is to remain Nil-By-Mouth
 The patient is to be nursed with an apnea monitor
 Monitor cannula as per local guidelines

10. Nursing Assessment
• Assessment in a child with pyloric stenosis include:
• 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.

11. Nursing Diagnosis
• 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.

12. Nursing Interventions
• Maintain adequate nutrition and fluid intake
• Provide mouth care
• Promote skin integrity
• Promote family coping

13. Bibiliography:
 Wong’s. (2005), Essentials of Pediatric nursing, 7th Edition, Elsevier Publications, New Delhi.
Page no: 880- 882.
 Parul Datta. (2007), Pediatric Nursing, 4th Edition, Jaypee publications, New Delhi. Page No:
262-263.
 Dorothy R. Marlow (2008), Textbook of Pediatric Nursing, 6th Edition, Elsevier
publications, New Delhi. Page No: 619-620.
 Venkatachalam S (2022), Target High, 6th Edition, CBS publishers, Delhi. Page No: 1017.
Websites:
• https://www.piernetwork.org/pyloric-stenosis.html
• https://nurseslabs.com/pyloric-stenosis/