Pyloric Stenosis

• IV. PYLORIC STENOSIS

  ● Narrowing of the pylorus, the lower part of the stomach through which food and other stomach contents pass to enter the small intestine.

  ● The incidence is high, approximately 1 in 150 in males and 1 in 750 in females.

  ○ It tends to occur most frequently in firstborn white male infants. The exact cause is unknown, but multifactorial inheritance is the likely cause.

  ● When an infant has pyloric stenosis, the muscles in the pylorus have become enlarged to the point where food is prevented from emptying out of the stomach.
• ● It occurs less frequently in breastfed infants than in formulafed infants.

  ○ Formula-fed infants typically begin having symptoms at approximately 4 weeks of age.

  ○ Breastfed infants begin having symptoms at 6 weeks

  ○ Because the curd of breast milk is smaller than that of cow’s milk, and it passes through a hypertrophied muscle more easily.
• DIAGNOSIS

  The diagnosis of pyloric stenosis is made primarily from history. Whenever parents say that their baby is vomiting or spitting up, be certain to get a full description:

  ● What is the duration? Begins at 6 weeks of age

  ● What is the intensity? Projectile vomiting

  ● What is the frequency? Immediately after eating

  ● What is the description of the vomitus? Sour but contains no bile

  ● Is the infant ill in any other way? No.
• ● At 4 to 6 weeks of age, infants begin to vomit almost immediately after each feeding, and is projectile.

  ○ The vomiting grows increasingly forceful until it becomes projectile, possibly projecting as much as three to four feet.

  ● With sour, non-bile vomitus.

  ○ Vomitus usually smells sour because it has reached the stomach and has been in contact with stomach enzymes. There is never bile in the vomiting of pyloric stenosis because the feeding does not reach the duodenum to become mixed with bile.
• ● Usually hungry immediately after vomiting because they are not nauseated.

  ○ Although it is difficult to assess whether nausea is present in infants, signs such as a disinterest in eating, excessive drooling, or chewing on the tongue may suggest this.

  ● May have signs of dehydration, alkalosis, hypopnea, and electrolyte imbalances.

  ○ Mainly because of the electrolyte loses especially when it is not corrected
• ● The definitive treatment of pyloric stenosis is surgical or laparoscopic pyloromyotomy known as RAMSTEDT’S PROCEDURE

  ○ It divides the muscle of the pylorus to open up the gastric outlet. This is a relatively straightforward surgery that can possibly be done through:

  1. Single incision, usually 3–4 cm long)

  2. Laparoscopically, through several tiny incision
• ● Surgery must be performed before electrolyte imbalance from vomiting or hypoglycemia from the lack of food occurs. The prognosis for infants with pyloric stenosis is excellent if the condition is discovered before an electrolyte imbalance occurs.

  ● For surgical correction, the muscle of the pylorus is split down to the mucosa, allowing for a larger lumen. Although the procedure sounds simple, it is technically difficult to perform, and there is a high risk for infection afterward because the abdominal incision is near the diaper area.