Pyloric Stenosis (2)

Question 1

What occurs here?

When does it typically present?

Answer 1

➊ Hypertrophy and narrowing of the pylorus, therefore preventing food from entering the duodenum

➋ In first 6-8 wks of life

Question 2

How does it present?
→ Why does this type of vomiting occur?

What may be felt O/E?

Answer 2

➊ • Projectile vomiting (i.e. spurting over a 1m away)
• Failure to thrive
→ After feeding, there’s powerful peristalsis to try and force stomach contents into the duodenum – As the pylorus is very narrow, the contents eject backwards into the oesophagus and out the mouth

➋ After feeding, hypertrophic pyloric sphincter may be felt as a firm, round olive-shaped mass

Question 3

Which investigations should be done?
→ Which acid-base imbalance will be seen if severe?

How is it managed?

Answer 3

➊ * US
* Blood gas
→ Hypochloremic Hypokalaemic metabolic alkalosis (low Cl- due to loss of HCl)

➋ * NBM, IVF
* Pyloromyotomy – Incision made in the smooth muscle of the pylorus to widen its opening