Hypertrophic Pyloric Stenosis

Question 1

Risk factors of HPS

Answer 1

Family history 
Male gender
Younger maternal age 
First born 
Maternal feeding

Question 2

Etiology

Answer 2

Genetic:male ;race ,family ,firstborn
Environmental: feeding ,erythromycin,seasonal
Other factors: increase substance p +gastrin
Decrease NO +neutrophil

Question 3

Diagnosis may be mistake with

Answer 3

GERD

Question 4

Features

Answer 4

Projectile no bilious vomiting contain recent feeding

Olive sign
Somnolence

Question 5

Lab

Answer 5

Hypochloremic

Hypo kaleemic
Metabolic alkalosis

Paradoxical aciduria

Question 6

The standard technique fo diagnosis HPS

Answer 6

ultrasound

Question 7

Ultrasound findings

Answer 7

Muscle thickness ≥ 4 mm (or > 3mm if <30 days of age)

Pyloric channel length ≥ 16 mm

Question 8

:

If US findings are equivocal

Answer 8

Upper GI series

String sign”
“Double track” sign

Question 9

Is HPS surgical emergency?

Answer 9

No

Question 10

Treatment

Answer 10

I’ve resuscitation&raquo_space; electrocyte correct&raquo_space;feeding

Pyloromyotomy

Other treatment:atropine +pyloric dilation

Question 11

Inadequate preop. resuscitation

Answer 11

persistent metabolic alkalosis
decreased respiratory drive
can lead to postoperative apnea

Question 12

M/c complication Inadequate preop. resuscitation

Answer 12

postoperative apnea

Question 13

M/C complications postoperative

Answer 13

Postoperative emesis

Question 14

Postoperative complications

Answer 14

Major complications include:
mucosal perforation (1-2%)
wound infection (1-2%)
incisional hernia (1%)
postoperative emesis (common | occur in most infants)
prolonged postoperative emesis (less common | 2-26% | due to GER or incomplete myotomy)
duodenal injury