Infantile Hypertrophic Pyloric Stenosis

Posted by e-Medical PPT Saturday, November 6, 2010
Infantile hypertrophic pyloric stenosis is a condition that causes severe vomiting in the first few months of life.There is narrowing of the opening from the stomach to the intestines, due to enlargement of the muscle surrounding this opening,which spasms when the stomach empties.Males are more commonly affected than females, with firstborn males affected about four times as often, and there is a genetic predisposition for the disease.
Babies with this condition usually present any time in the first weeks to months of life with progressively worsening vomiting. The vomiting is often described as non-bile stained ("non bilious") and "projectile vomiting".Some infants present with poor feeding and weight loss, but others demonstrate normal weight gain. Dehydration also can occur causing the baby to cry without having tears, and having less wet or dirty nappies such as going hours or a couple days without having anything.Constant hunger, belching, and colic are other possible signs as the baby is not able to eat properly.On exam, palpation of the abdomen may reveal a mass in the epigastrium.This mass, which consists of the enlarged pylorus, is referred to as the 'olive,' and is sometimes evident after the infant is given formula to drink.There are often palpable (or even visible) peristaltic waves due to the stomach trying to force its contents past the narrowed pyloric outlet.
In most cases of pyloric stenosis are diagnosed with ultrasound.Blood tests will reveal hypokalemic, hypochloremic metabolic alkalosis due to loss of gastric acid via persistent vomiting; these findings can be seen with severe vomiting from any cause. The potassium is decreased further by the body's release of aldosterone, in an attempt to compensate for the hypovolaemia due to the severe vomiting.
The definitive treatment of pyloric stenosis is with surgical pyloromyotomy known as Ramstedt's procedure.This is a relatively straightforward surgery that can possibly be done through a single incision or laparoscopically .

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