STENOSIS PYLORIC HYPERTROPHIC...HYPERTROPHIC PYLORIC STENOSIS Mohammad Damseh an enlarged,...
Transcript of STENOSIS PYLORIC HYPERTROPHIC...HYPERTROPHIC PYLORIC STENOSIS Mohammad Damseh an enlarged,...
HYPERTROPHIC PYLORICSTENOSISMohammad Damseh
• Introduction
• Pathophysiology
• Signs and symptoms
• Diagnosis
• Treatment
• It is a disease of early infancy - Affects a very limited age group 3-6 weeks. It rarely affects a childmore than 2 months of younger than 3 weeks of age. We can find atypical cases under the age of 3weeks or more than 6 weeks
• hypertrophy of the pyloric muscles and this hypertrophy causes pyloric obstruction.
• Male: female ratio is 4-6:1
• Overall incidence: 3/1000 live births.
• It is one of the most common surgical conditions in the west, so there is a strong racial variation
• There are genetic factors’ - tendency increases if the mother is affected more than if the father Isaffected
Pathophysiology:
� Hypertrophy of the smooth muscles of the antrum due to unknown reasons. This causesnarrowing of the pyloric canal, which becomes easily obstructed.
• Vigorous peristalsis• Hypertrophy of the stomach• Gastritis, hematemesis, dehydration
• The end result is hypokalemic hypochloremic metabolic alkalosis andparadoxical acidurea.
o How did the pathophysiology come into being?
• Failure of relaxation, which results in spasms• Abnormal ganglia were found in some cases, but not all of them• Deregulation of the VIP, nitric oxides, and polypeptides of the GIT.
symptoms:• Progressive, persistent, projectile, non-bilious vomiting. - The baby is usually hungry after vomiting• Constipation is typical• Gastritis due to prolonged vomiting and hematemesis, which will lead to anemia due to chronic loss
of blood.
Signs▪ Olive sign: the enlarged pyloric canal is felt during physical
examination like an olive to the right of the vertebral columnjust below the liver.
▪ Succusion splash: After ingestion of fluids, the patient’sstomach will produce audible sounds
when moving the patient▪ Visible peristalsis: you may see peristaltic waves of the stomach
from left to right..
Diagnosis:
• Typical clinical picture in 90% of the patients.
• Ultrasound
• Barium swallow
• Serum electrolytes, CBC, and pH
Abdominal ultrasound: Confirms diagnosis with 95% sensitivity
Criteria for diagnosis:
Pyloric length : 3-4mm Pyloric length : 15-19mm
Barium meal
Elongated narrowpyloric Canal “stringsign”
Parallel streaks of bariumseen in the narrowedchannel “double tractsign”
Bulge of pyloric muscle intoantrum “shoulder sign”
Markedly dilated stomach
Mushroom sign
• Hypokalemia Hyperchloremic metabolic alkalosis• Hyponatremia
Serum electrolytes, CBC, and pH
Treatment
Medical treatment
• correct dehydration and acid base imbalances.• Antispasmodic before feeds• Small, thick, frequent feeds• Keep upright for 1 hour after feeding
Surgical treatment
• Ramsted’s pyloromyotomy
Thank you