Pyloric Stenosis

Background

  • Hypertrophy of the pyloric sphincter causes narrowing of the gastric outlet
  • Most common cause of gastric obstruction in patients 2-12 weeks old
  • Risk factors include male (4:1); firstborn (2:1); white/caucasian; term infants; bottle-fed babies

Presentation

  • Usually present around 3-6 weeks with a history of progressively worsening non-billious vomiting (may be projectile) after feeds
    • may be blood stained
  • Associated with
    • poor weight gain, decreased urine output (fewer wet nappies) and stools, excessive hunger, dry mucous membranes and depressed fontanelle
    • rarely, once severe, tachycardia and jaundice may occur
  • Assess degree of dehydration; weight
  • Observe a normal feed
  • Examination of the abdomen may reveal an epigastric ‘olive-shaped’ mass

Investigations

  • Blood tests to consider include FBC, U&Es, venous acid-base, glucose, bilirubin
    • Hypokalaemia and hypochloraemia (possibly hyponatraemia)
    • Metabolic alkalosis
  • USS can usually identify hypertrophied pylorus
    • Contrast studies may be used if USS unequivocal

Management

  • Fluid resuscitation- correct any electrolyte disturbance (particularly hypokalaemia) prior to surgery
  • Nil by mouth and nasogastric drainage or suction prior to surgery and between feeds
  • Surgery
    • Pyloromyotomy
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