Hypertrophic pyloric stenosis occurs when the pyloric sphincter muscle thickens, narrowing the stomach outlet. It typically affects young infants, especially firstborn males. Projectile vomiting after feeding is the main symptom. Diagnosis involves abdominal x-ray or ultrasound showing thickening of the pylorus. Surgical pyloromyotomy is the standard treatment and relieves the obstruction by cutting the thickened muscle. Nursing care focuses on maintaining nutrition, hydration and family support until surgery can be performed.
2. Definition:
• Pyloric Stenosis is not a congenital Disorder.
• Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric
sphincter becomes thickened, resulting in elongation and narrowing of the pyloric
channel and leads to partial or total obstruction of the stomach outlet.
6. Clinical Manifestations:
Projectile Vomiting
May be ejected 3-4 feet from the child when in a side lying position, 1feet or more when in a
back lying position.
Occurs shortly after a feeding
May follow each feeding or appear intermittently
Nonbilious vomitus
May be blood tinged
Infant Hungry- Eagerly accepts the second feeding after vomiting episode
No evidence of pain or discomfort
Weight loss
Signs of dehydration
Distended upper abdomen
Olive like mass on the right upper quadrant of the abdomen
Visible gastric peristaltic waves that move from left to right across the
epigastrium.
7. Diagnostic Evaluation:
HC
PE
Abdominal X-ray
Barium Meal X-ray- Elongated pyloric canal (string sign) or thickened pyloric mucosa (double
track sign)
USG
Decreased serum levels of both sodium and potassium
Decreased in serum chloride level and increases in pH and bicarbonate
Increased BUN level
Urine examination
Blood examination for Hb%.
9. Nursing Considerations:
Weight on admission, recorded as baseline
Blood pressure (at least a baseline recording)
2 Hourly Aspiration of NGT
4 Hourly observations (or as clinical needs dictate)
Temperature
Heart rate
Respiratory rate
6 hourly monitoring of blood sugar while on IV fluids
The patient is to remain Nil-By-Mouth
The patient is to be nursed with an apnea monitor
Monitor cannula as per local guidelines
10. Nursing Assessment
• Assessment in a child with pyloric stenosis include:
• Assess the child’s history of vomiting. Ask when the vomiting started and
determine the character of the vomiting.
• Assess for the child’s elimination. Ask the caregiver about constipation and
scanty urine.
• Physical exam. Physical exam reveals an infant who may show signs of
dehydration; obtain the infant’s weight and observe skin turgor and skin condition,
anterior fontanelle, temperature, apical pulse rate, irritability, lethargy, urine, lips and
mucous membranes of the mouth, and eyes; observe for visible gastric peristalsis
when the infant is eating.
11. Nursing Diagnosis
• Based on the assessment data, the major nursing diagnoses are:
Imbalanced nutrition: less than body requirements related to inability
to retain food.
Deficient fluid volume related to frequent vomiting.
Impaired oral mucous membrane related to NPO status.
Risk for impaired skin integrity related to fluid and nutritional deficit.
Compromised family coping related to seriousness of illness and
impending surgery.
12. Nursing Interventions
• Maintain adequate nutrition and fluid intake
• Provide mouth care
• Promote skin integrity
• Promote family coping
13. Bibiliography:
Wong’s. (2005), Essentials of Pediatric nursing, 7th Edition, Elsevier Publications, New Delhi.
Page no: 880- 882.
Parul Datta. (2007), Pediatric Nursing, 4th Edition, Jaypee publications, New Delhi. Page No:
262-263.
Dorothy R. Marlow (2008), Textbook of Pediatric Nursing, 6th Edition, Elsevier
publications, New Delhi. Page No: 619-620.
Venkatachalam S (2022), Target High, 6th Edition, CBS publishers, Delhi. Page No: 1017.
Websites:
• https://www.piernetwork.org/pyloric-stenosis.html
• https://nurseslabs.com/pyloric-stenosis/