Pediatric: Hypertrophic Pyloric Stenosis Flashcards
What is…Pediatric Hypertrophic Pyloric Stenosis?
What is it the most common cause of?
causes a functional gastric outlet obstruction as a result of hypertrophy and hyperplasia of the muscular layers of the pylorus. In infants, hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction and the most common surgical cause of vomiting.
Where is the Plyorus located?
Before the small intestine and the end of the stomach, right at the Ploric vlave.
What are the symptoms of hypertrophic pyloric stenosis?
What are the signs?
Severe vomiting in 3-6 weeks, Deuodum is narrowed, gastric reflux in infants when they have lower relaxation in eshophagus sphincter.
Poor feeding, then dehydration, crying without tears, less wet nappies, belching, cholic
What is the rate of vomiting and how does it persue?
Starts off infrequent and then after each feeding.
Soon it will become intense until pathognomonic projectile vomiting ensues.
How do you examine for an enlarged Pyloric valve? Whats the olive idea?
An enlarged pylorus, classically described as an “olive,” can be palpated in the right upper quadrant or epigastrium of the abdomen in 60-80% of infants.
Physical examination and radiographic studies
What most be done before surgical repair?
Serum electrolytes should be measured to document adequacy of fluid resuscitation and correction of electrolyte imbalances before surgical repair.
What is the biochemical abnormality in hypertrophic pyloric stenosis?
hypochloremic, hypokalemic metabolic alkalosis. The loss of Chloride ions and of primary increase in serum bicarbonate (HCO3 -) concentration. This occurs as a consequence of a loss of H+
How is Ultrasonography used for this problem?
The criterion standard imaging technique for diagnosing hypertrophic pyloric stenosis
Muscle wall thickness 3 mm or greater and pyloric channel length 14 mm or greater are considered abnormal in infants younger than 30 days
What are 2 types of alkolosis?
Respiratory and metabolic
What composes of Gastric acid?
Hydrochlorid acid, and potassium
What is Hypokalemic?
when their is drop of potassium ions
Whatr is the surgical solution? What 2 parts are you splitting?
Surgical pyloromyotomy
The usual approach is via a right upper quadrant transverse incision that splits the rectus muscle and fascia
