Pyloric stenosis
Definition
Pyloric stenosis is a narrowing of the pyloric sphincter due to hypertrophy of the pylorus. It is also known as hypertrophic and congenital hypertrophic pyloric stenosis.
Epidemiology
There is a 4:1 male:female ratio and the condition presents at 6-8 week old babies and it occurs in 1 in 500 live births.
Pathophysiology
Basically, the pylorus, a muscular bit at the bottom of the stomach, gets really big. In doing so, it blocks the exit to the stomach. This prevents food from passing out of the stomach. Essentially, this means that food can only pass out of the body back the way it came. The pylorus is the part of the stomach used in the vomiting and given the hypertrophy characteristic of the condtion the extra muscle causes projectile vomiting.
Risk Factors
- First-born male sex (4x risk of general population)
- African-American (3x risk)
- Family Hx
- Caucasian babies of blood type B or O are more likely to be affected (not a clue why, though)
Clinical Features
The key clinical feature is projectile vomiting. This is defined loosely as 'vomiting over the far end of the cot'. It goes a country mile. The vomitus should not be bile-stained as the vomit has yet to enter the duodenum. Other features are:
- No diarrhoea
- Constipation (possible 'starvation stools')
- Signs Of Dehydration
- Visible peristaltic wave in left upper quadrant from left-to-right (late presentation)
- Olive-size mass on left
- To palpate, stand on baby's left during a feed, palpating lateral border of right upper quadrant
Investigations
- Measure urine output
Bloods
- FBC - rule out infection (WCC normal)
- U+Es - dehydration (deranged electrolytes, particularly Na+,
Cl-, and K+) Imaging
- Ultrasound, but only when there are no findings on examination
Management
Surgery (apparently a Ramstedt's pylormotomy). You don't need to know how to perform this procedure givent it's pretty complicated.
Assuming the child is not in shock or its life is not in immediate danger, the condition should be managed semi-urgently. The child has survived this far and emergency treatment isn't going to make things better any more effectively than semi-urgent treatment.