Name
PYLORIC STENOSIS
DESCRIPTION
DETAIL
CAUSES β’ Obscure, sometimes familial; 6% risk of recurrence if either parent had pyloric stenosis, much higher if the mother was affected -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Inexperienced or inappropriate feeding β’ Gastroesophageal reflux β’ Gastritis β’ Congenital adrenal hyperplasia, salt-losing β’ Pyloric diaphragm β’ PylorospasmLABORATORY β’ Early - evidence hypochloremic alkalosis, with low serum chloride and high bicarbonate β’ Later - may have acidosis with low bicarbonate and low potassium β’ Elevated unconjugated bilirubin level SPECIAL TESTS Abdominal ultrasound by experienced radiologist will usually outline the pyloric tumor IMAGING β’ Upright plain film of abdomen may reveal dilated stomach (filled with fluid and/or air) and relative lack of air in intestines β’ Ultrasound (first choice if available) shows thickened and elongated pyloric muscle β’ Barium swallow (performed only when diagnosis is not clinically clear) reveals strong gastric contractions and elongated, narrow pyloric canal (string sign); now rarely performed if ultrasound available
TYPENOTES
RISK FACTORS 2.5 times more common in Caucasians than in blacksSURGICAL MEASURES Surgery must be preceded by preoperative preparation, including: Empty stomach with nasogastric tube, fl uid replacement, correction of electrolyte imbalance DIET β’ No preoperative feeding β’ No feeding for 8-16 hours postoperative β’ Gradual increase in feedings thereafter β’ Should reach full feedings 48-72 hours after surgery PATIENT MONITORING Routine pediatric health maintenance POSSIBLE COMPLICATIONS β’ No long term morbidity β’ Occasional postoperative wound infection with staph aureus EXPECTED COURSE/PROGNOSIS Complete recovery with catch-up growth and weight gain
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
SERUM POTASSIUM, SERUM CHLORIDE, X-RAY ABDOMEN A.P. VIEW FOR KUB, X-RAY BARIUM UPPER G.I., ULTRA SOUND WHOLE ABDOMEN - FEMALE, ENDOSCOPY UPPER G.I., CT SCAN ABDOMEN, SERUM BICARBONATE