STENOSIS PYLORIC HYPERTROPHIC...HYPERTROPHIC PYLORIC STENOSIS Mohammad Damseh an enlarged, thickened, "olive-shaped," non-tender pylorus may be palpable in the epigastrium. The primary

HYPERTROPHIC PYLORICSTENOSISMohammad Damseh

an enlarged, thickened, "olive-shaped," non-tender pylorus may be palpable in the epigastrium. The primary symptom of the condition is projectile, nonbilious vomiting immediately after feeding.

• Introduction

• Pathophysiology

• Signs and symptoms

• Diagnosis

• Treatment

Hypertrophic pyloric stenosis – the most common cause of gastric outlet obstruction in infants – is characterized by hypertrophy and hyperplasia of the pyloric sphincter in the first months of life. Clinical manifestations usually appear between three and five weeks of age. The primary symptom is regurgitation progressing to nonbilious, projectile vomiting, which occurs intermittently or after feeding. The infant is irritable and demonstrates a strong rooting and sucking reflex because of hunger. Constant vomiting leads to hypokalemic and hypochloremic metabolic alkalosis. The diagnosis is usually clinical and involves the detection of a palpable "olive-shaped" structure in the epigastrium (a sign of marked hypertrophy of the pylorus) and visible gastric peristalsis proximal to the site of obstruction. The condition may also be diagnosed on ultrasound in the absence of a palpable “olive-shaped” structure. Initial management involves adequate rehydration and correction of electrolyte imbalances. The definitive treatment is Ramstedt pyloromyotomy

• It is a disease of early infancy - Affects a very limited age group 3-6 weeks. It rarely affects a childmore than 2 months of younger than 3 weeks of age. We can find atypical cases under the age of 3weeks or more than 6 weeks

• hypertrophy of the pyloric muscles and this hypertrophy causes pyloric obstruction.

• Male: female ratio is 4-6:1

• Overall incidence: 3/1000 live births.

• It is one of the most common surgical conditions in the west, so there is a strong racial variation

• There are genetic factors’ - tendency increases if the mother is affected more than if the father Isaffected

Pathophysiology:

� Hypertrophy of the smooth muscles of the antrum due to unknown reasons. This causesnarrowing of the pyloric canal, which becomes easily obstructed.

• Vigorous peristalsis• Hypertrophy of the stomach• Gastritis, hematemesis, dehydration

• The end result is hypokalemic hypochloremic metabolic alkalosis andparadoxical acidurea.

o How did the pathophysiology come into being?

• Failure of relaxation, which results in spasms• Abnormal ganglia were found in some cases, but not all of them• Deregulation of the VIP, nitric oxides, and polypeptides of the GIT.

symptoms:• Progressive, persistent, projectile, non-bilious vomiting. - The baby is usually hungry after vomiting• Constipation is typical• Gastritis due to prolonged vomiting and hematemesis, which will lead to anemia due to chronic loss

of blood.

Signs▪ Olive sign: the enlarged pyloric canal is felt during physical

examination like an olive to the right of the vertebral columnjust below the liver.

▪ Succusion splash: After ingestion of fluids, the patient’sstomach will produce audible sounds

when moving the patient▪ Visible peristalsis: you may see peristaltic waves of the stomach

from left to right..

Diagnosis:

• Typical clinical picture in 90% of the patients.

• Ultrasound

• Barium swallow

• Serum electrolytes, CBC, and pH

Abdominal ultrasound: Confirms diagnosis with 95% sensitivity

Criteria for diagnosis:

Pyloric length : 3-4mm Pyloric length : 15-19mm

Barium meal

Elongated narrowpyloric Canal “stringsign”

Parallel streaks of bariumseen in the narrowedchannel “double tractsign”

Bulge of pyloric muscle intoantrum “shoulder sign”

Markedly dilated stomach

Mushroom sign

• Hypokalemia Hyperchloremic metabolic alkalosis• Hyponatremia

Serum electrolytes, CBC, and pH

Treatment

Medical treatment

• correct dehydration and acid base imbalances.• Antispasmodic before feeds• Small, thick, frequent feeds• Keep upright for 1 hour after feeding

Surgical treatment

• Ramsted’s pyloromyotomy

Thank you

Documents

STENOSIS PYLORIC HYPERTROPHIC...HYPERTROPHIC PYLORIC STENOSIS Mohammad Damseh an enlarged, thickened, "olive-shaped," non-tender pylorus may be palpable in the epigastrium. The primary