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Pyloric stenosis

{{{Name|Pyloric stenosis}}}
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| 
 ICD9        = 750.5|

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{{{Name|Pyloric stenosis}}}
[[Image:{{{Image}}}|190px|center|]]
{{{Caption|}}}
ICD-10 {{ICD10
ICD-O: {{{ICDO}}}
ICD-9 {{{ICD9}}}
OMIM }}}
MedlinePlus }}}
eMedicine }}}
DiseasesDB }}}
| 
 ICD9        = 537.0|

}} Infantile Pyloric stenosis is an uncommon pediatric condition where there is a congenital narrowing of the pylorus(the opening at the lower end of the stomach). Males are more commonly affected than females.

(Note: Pyloric stenosis also occurs in adults where the cause is usually a narrowed pylorus due to scarring from chronic peptic ulceration. This is a different condition from infantile hypertrophic pyloric stenosis.)

Inhaltsverzeichnis

  • 1 Symptoms
  • 2 Diagnosis
  • 3 Pathophysiology
  • 4 Treatment
  • 5 Reference
  • 6 External links

Symptoms

Babies with this condition usually present within the first few weeks (usually between 2nd and 3rd) of life with poor feeding, weight lossand progressively worsening vomitingleading ultimately to projectile non-biliousvomiting.

Diagnosis

Diagnosis is via a careful history and physical examination. Palpationof the abdomen during a test feed may reveal a mass in the epigastriumconsisting of the enlarged pylorus (pyloric tumour) with palpable peristalticwaves consisting of the stomach trying to force its contents past the narrowed pylorus.

Blood tests will reveal hypochloremic alkalosissecondary to loss of acidic gastric secretions due to persistent vomiting.

A pediatric surgeon would typically be able to palpate a pyloric tumour in about 80% of cases. Such a tumour is much more commonly not detected by less experienced medical staff. If no tumour is palpated despite a significant clinical suspicion, an imaging study should be performed.

Ultrasoundexamination will show hypertrophied pyloric musculature, sometimes greater than 4 mm. A barium meal may be useful in cases which ultrasound is not readily available.

Pathophysiology

The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the duodenum. As a consequence all ingested food and gastric secretions can only exit via vomiting which can be of a projectile nature. The vomited material does not contain bilebecause the pyloric onstruction prevents entry of duodenal contents (containing bile) into the stomach.

This results in loss of gastric acid (hydrochloric acid). The chlorideloss results in hypochloremiawhich impairs the kidney's ability to excrete bicarbonate. This is the significant factor that prevents correction of the alkalosis. [1].

A secondary hyperaldosteronismdevelops due to the hypovolaemia. The high aldosteronelevels causes the kidneys to:

  • avidly retain Na+ (to correct the intravascular volume depletion)
  • excrete increased amounts of K+ into the urine (resulting in hypokalaemia).

The body's compensatory response to the metabolic alkalosis is hypoventilation resulting in an elevated arterial pCO2.

Treatment

Infantile pyloric stenosis is not a surgical emergency, but if not fixed via surgery, the infant will die of malnutrition and dehydration.

Initially the baby's condition must be improved by correcting the dehydrationand hypochloremic alkalosiswith IV fluids. This can usually be accomplished in about 24-48 hours.

Definitive treatment of pyloric stenosis is with surgicalpyloromyotomy - dividing of the musclelayer of the pylorusto open up the the gastric outlet (distal opening of the stomach). Once the stomach can empty into the duodenumfeeding can commence.

Reference

  • Hulka F, Campbell TJ, Campbell JR, Harrison MW. Evolution in the recognition of infantile hypertrophic pyloric stenosis. Pediatrics 1997;100(2):E9. Fulltext. PMID 9233980.

External links

  • eMedicine
  • NIH/Medline
  • UCL Institute of Child Health
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Retrieved from "http://en.wikipedia.org/Pyloric_stenosis"



This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Pyloric+stenosis Wikipedia article Pyloric stenosis.

 
  All text is available under the terms of the GNU Free Documentation License