Pyloric stenosis

1. PYLORIC STENOSIS
&
CONGENITAL GASTRIC OUTLET
OBSTRUCTION
BY
DR PULLA UMA
MAHESWARI
DEPARTMENT OF
PAEDIATRICS

2. • Pyloric stenosis is a thickening or swelling of the
pylorus — the muscle between the stomach and the
intestines — that causes severe and forceful vomiting
in the first few months of life.
• It is also called infantile hypertrophic pyloric stenosis.
It is common cause of gastric outlet obstruction in
infants

3. INCIDENCE
• Pyloric stenosis is relatively common and occurs in approximately 2 to 5
infants per 1,000 live births.
• It is more prevalent in first-born males and is often diagnosed between 3
to 12 weeks of age.

4. CAUSES
• The enlargement of the pylorus causes a narrowing (stenosis) of the opening
from the stomach to the intestines, which blocks stomach contents from
moving into the intestine.
• The exact cause of pyloric stenosis is unknown. However, genetic factors are
believed to play a role, as the condition tends to run in families.

5. • There is genetic predisposition to the development of IHPS.
• In addition to the variability among races and clear male preponderance,
there is an increased risk to the first born infants with a positive family
history and certain ABO blood types, elevated gastrin levels, higher
concentrations of neurotransmitter substance P and a decrease in nerve
supporting cells in muscle layers have all been implicated in pylorospasm
and muscle hypertrophy

6. RISK FACTORS
• Male sex (especially first-born boys)
• Parents or siblings who had pyloric stenosis
• Use of certain antibiotics (for example, erythromycin) during the first few
weeks of life
• Smoking during pregnancy
• Bottle-feeding with formula

7. CLINICAL FEATURES
• 2nd – 8th week of life
• Projectile, frequent non bilious vomiting
30-60 mins after feeding
• Persistent hunger
• Jaundice (2%) – due to decreased
glucoronosyl transferase associated with
starvation
• On examination olive mass on upper
abdomen

8. 1. Persistent hunger: Despite feeding, infants with pyloric stenosis remain
hungry due to the obstruction preventing proper food passage.
2. Weight loss: The inability to retain and digest enough food often leads to
poor weight gain or even weight loss.
3. Dehydration: Vomiting can result in significant fluid loss, leading to
dehydration, which may be accompanied by dry mouth, decreased urination,
and sunken fontanelles (the soft spots on an infant's head).
4. Constant hunger and irritability: Infants may become increasingly irritable
and show signs of distress due to their hunger and inability to adequately
feed.

9. • After several days to weeks, infants
become progressively dehydrated and
lose weight.
• Some infants have a yellowish
discoloration of the skin and the
whites of the eyes (jaundice) at this
point.

10. DIAGNOSIS
• Non-bilious projectile vomiting, visible gastric peristalsis and
hypochloraemic hypokalemic metabolic alkalosis are cardinal features of
IHPS.
• A definitive diagnosis can be made in 75% of the infants with IHPS by careful
physical examination
• To be successful in palpating the pyloric olive, the infant must be calm and
cooperative. The examiner should be ready to commit 5–15 minutes for
proper examination. Examination with a pacifier or just after feeds could be
more successful

11. • Ultrasonography is the most common
imaging technique for the diagnosis.
• The commonly used criteria on
ultrasonography include a pyloric muscle
thickness of 4 mm and a pyloric channel
length of 16 mm or more.
• Blood Tests: Blood tests may be ordered to
assess the infant's electrolyte levels and to
check for signs of dehydration or other
abnormalities.

12. TREATMENT
• The standard treatment for pyloric stenosis is surgery called a
pyloromyotomy.
• The key to successful operation is the extramucosal operation of
the pyloric muscle from near the pyloroduodenal junction well
onto the normal stomach.
• Classical Pyloromyotomy (Ramstedt Operation)

13. COMPLICATIONS
• If left untreated, pyloric stenosis can lead to severe dehydration, electrolyte
imbalances, and malnutrition.
• Prompt diagnosis and treatment are crucial to prevent these complications.
PROGNOSIS
With appropriate treatment, the long-term prognosis for infants with pyloric
stenosis is excellent.
The surgery typically provides a complete resolution of symptoms, and infants
can resume normal feeding and thrive.

15. CONGENITAL GASTRIC OUTLET
OBSTRUCTION

16. • Congenital gastric outlet obstruction refers to a blockage or narrowing
in the region where the stomach empties its contents into the small
intestine.
• It is a rare condition that occurs in infants and is present at birth
(congenital).
• This obstruction prevents or hinders the normal passage of food from
the stomach to the small intestine, leading to symptoms such as
vomiting and feeding difficulties.

17. TYPES
 Pyloric Stenosis: This is the most common type, characterized by the
thickening and narrowing of the pylorus, the muscular valve at the outlet of
the stomach.
 Antral Web: A thin, membranous tissue forms across the outlet of the
stomach, obstructing the passage of food.

18.  Hypertrophic Pyloric Muscularis Propria: An overgrowth of the muscular
layer of the pylorus causes narrowing and obstruction.
 Pyloric Atresia: Complete blockage or absence of the pyloric channel.
 Duplication Cyst: A cystic structure near the pylorus obstructs the flow of
food

19. CLINICAL FEATURES
• Vomiting: Forceful, non-bilious vomiting typically occurs shortly after
feeding.
• Abdominal Distention: The abdomen may appear swollen or distended.
• Failure to Thrive: Infants may experience poor weight gain and growth
due to inadequate nutrition.
• Dehydration: Vomiting can lead to dehydration if fluids are not
adequately replaced.

20. DIAGNOSIS
 Physical Examination: A mass or lump may be palpable in the abdomen,
depending on the type and severity of the obstruction.
 Imaging Studies: Ultrasound is commonly used to visualize the pylorus and
assess the degree of obstruction. An upper gastrointestinal series, which
involves X-rays after the ingestion of contrast material, may also be performed.
 Laboratory Tests: Blood tests may be done to evaluate electrolyte imbalances,
such as low levels of potassium due to vomiting.

21. TREATMENT
 Surgical Intervention: The primary treatment for congenital gastric outlet
obstruction is surgery. The specific procedure depends on the type and
severity of the obstruction. Examples include pyloromyotomy (surgical
incision to relieve pyloric stenosis) or resection of the obstruction.
 Medical Management: Before surgery, infants may require intravenous
fluids to correct dehydration and electrolyte imbalances.

22. COMPLICATIONS
 Malnutrition: Prolonged obstruction can lead to malnutrition and failure
to thrive if not addressed promptly.
 Dehydration and Electrolyte Imbalances: Persistent vomiting can cause
dehydration and imbalances in electrolyte levels, requiring medical
intervention.
 Delayed Diagnosis: If the condition is not recognized and treated in a
timely manner, there is an increased risk of complications and long-term
effects on growth and development.

23. PROGNOSIS
• With appropriate treatment, the prognosis for infants with congenital
gastric outlet obstruction is generally favorable.
• Most infants experience significant improvement in symptoms and can
resume normal feeding and growth after surgical intervention.

24. HOMOEOPATHIC MANAGEMENT
Although In allopathic system surgery is the only treatment.... but here
HOMEOPATHY.... it shows wonderful result in pyloric stenosis, bringing back
the hypertrophied muscles back to its normal size thus relieving from pain and
distress and also the side effects of surgery on young ones.

25. RUBRICS

26. • Aethusa Cynapium – Homeopathic Medicine for Reflux in Infants who Vomit
After Intake of Milk
• Calcarea Carb – Natural Treatment for Gastric Reflux in Babies with Sour
Smelling Vomiting
• Ornithogalum – painful contractions in the pylorus with duodenal distension ,
pain increased when food passes pyloric outlet. Vomiting of coffee ground
looking matter
• Dysentery bacillus – spasm in pylorus , retention of digested contents , cyclical
vomiting in children