Pyloric stenosis Flashcards
1
Q
Pyloric stenosis - background (3)
A
- Def = progressive thickening of circular muscle of pylorus, leading to gastric outlet narrowing
- Epi = 3/1000, usually presents between 2-6 weeks of age
- Cause remains unknown. RF = fhx, male, Caucasian
2
Q
Pyloric stenosis - clinical features
A
- Vomiting = projectile (may not be in babies who present early/first or second week), always non-bilious but may contained altered blood (‘coffee ground’) or fresh blood from esophagitis. Occurs within an hour of feeding and baby is immediately hungry
- Constipation = common, due to reduced fluid intake
Late signs
- Dehydration
- FTT, weight loss/inadequate weight gain
- Jaundice - cause unknown, 2% of cases
3
Q
Pyloric stenosis - ix (3)
A
- Test feed = baby allowed to feed from breast or bottle whilst examiner palpates abdomen; may see visible waves of gastric peristalsis, can feel thickened pylorus as a firm, ‘olive-shaped’ mass
- If tumour (?) cannot be felt, U/S will usually confirm or exclude the dx
- Bloods (5) = FBE, UEC, venous blood gas, BGL, bilirubin (if jaundiced)
4
Q
Pyloric stenosis - mx
A
- May need fluid resuscitation with 10-20mL/kg boluses of normal saline, for pts with moderate to severe dehydration/shock
- Commence IV fluids (0.45% NS + 5% dextrose + 20mmol KCl/L), 100mL/kg/d, review after 4-6hrs
- Withhold feeds; empty stomach with NGT, replace nasogastric losses with IV NS
- Repeat UEC, VBG and BGL 4-6 hourly
- Ramstedt’s pyloromyotomy = splitting the thickened pyloric muscle. Complications = perforation of mucosa, wound infection, transient post-operative vomiting. Oral feeds withheld overnight, start within 6hrs post-op. Discharge within 3d. Restenosis can occur, but is uncommon (1-2%)
