Hypertrophic pyloric stenosis is a condition in infants where the muscle surrounding the pylorus (opening from the stomach to the small intestine) thickens, causing projectile vomiting after feeding. It most often affects young babies, especially boys. Surgery to cut the thickened pyloric muscle (pyloromyotomy) corrects the problem and stops the vomiting. With proper pre- and post-operative care including IV fluids, feeding, monitoring for complications, infants usually recover well after surgery.
2. INTRODUCTION
• Due to enlargement
(hypertrophy) of the muscle
surrounding this opening which
spasms when the stomach
empties.
• This condition causes severe
projectile non-bilious vomiting.
• It most often occurs in the
first few months of life.
3.
4. • It more specifically labelled as
“infantile hypertrophic pyloric stenosis”.
• The thickened pylorus is felt classically as an olive-
shaped mass in the middle upper part or right
upper quadrant of the infant's abdomen.
5. DEFINITION
• Pyloric stenosis is defined as “narrowing (stenosis)
of the outlet of the stomach so that food cannot
pass easily from it into the duodenum, pyloric
stenosis results in feeding problems and projectile
vomiting.”
6. ETIOLOGY
• Idiopathic
• Nitric oxide syntheses deficiency
• Sex: Pyloric stenosis is seen more often in boys — especially
first born children — than in girls.
• Premature birth: Pyloric stenosis is more common in babies
born prematurely than in full-term babies.
7. • In family where one child has had pyloric stenosis, there is an
increased chance that future off spring may have this
condition.
• Smoking during pregnancy:
This behavior can nearly double
the risk of pyloric stenosis.
8. PATHOPHYSIOLOGY
Gastric outlet obstruction due to hypertrophy, which impairs emptying of
gastric contents into duodenum.
So all ingested food and gastric content can only exist by vomiting which
is projectile in nature.
Persistent vomiting cause loss of HCL and dehydration.
The chloride loss results in a low blood chloride level which impairs the
kidney's ability to excrete bicarbonate. This is the significant factor that
cause hydrochloremic alkalosis.
9. CLINICAL MANIFESTATION
• Vomiting after feeding - The baby may vomit
forcefully, ejecting breast
milk or formula up to several feet away
(projectile vomiting). Vomiting might be mild
at first and gradually become more severe
as the pylorus opening narrows.
10. • Persistent hunger - Babies who have pyloric
stenosis often want to eat soon after vomiting.
• Stomach contractions - Notice wavelike
peristalsis that ripple across baby's upper
abdomen soon after feeding, but before
vomiting. This is caused by stomach muscles
trying to force food through the narrowed
pylorus.
11. • Dehydration
• Lethargic
• Constipation
• Weight loss
• Olive shaped mass “pyloric tumor” at angle
between right rectus muscle and liver.
12. DIAGNOSIS
• Physical examination reveals – a firm, olive sized
mass in epigastrium.
• Barium study of upper GI tract
• Blood test reveals – low sodium, potassium,
chloride level, increased bicarbonate level.
• Due to dehydration urine becomes concentrated.
13. MEDICAL MANAGEMENT
• Infantile pyloric stenosis is typically managed
with surgery; very few cases are mild enough to
be treated medically.
• Therefore, the baby must be initially stabilized
by correcting the dehydration and the
abnormally high blood pH seen in combination
with low chloride levels with IV fluids.
14. SURGICAL MANAGEMENT
• An operation called “pyloromyotomy” or “fredetramstedt”
sugery is performed. This surgery opens up the tight
circular muscles of pylorus that had caused the narrowing,
thereby allowing passage of food from stomach to intestine.
15. NURSING MANAGEMENT
PRE - OPERATIVE NURSING MANAGEMENT
• Observe and record the vital sign.
• Record the amount and characteristics of vomitus and stool.
• Stop oral feeding and administer IV fluids.
• If oral feed is given, feed slowly and burp frequently to prevent
vomiting.
• After feeding make sure head end of bad is elevated.
• Weight the baby daily.
• Maintain intake and output chart.
• Provide warmth and protect from infections.
• Prior to surgery gastric lavage is done with NS
16. POST – OPERTIVE NURSING
MANAGEMENT
1. Observe the sign of complication.
• Observe the incision for sign of infection.
• Check for presence of any discharges from incision.
• Keep the incision clean and dry.
• Use aseptic techniques while dressing.
• Monitor abdominal girth to detect abdominal
distension.
• Don’t give tub bath to baby till the incision heals.
17. • Monitor temperature hourly until stable.
• Routine post anaesthetic observations.
• Monitor wound and report abnormalities to
surgeon.
• Observe for bleeding, redness, swelling, ooze
from incision site.
18. 2. Management of pain.
• To minimize pain administer acetaminophen.
• Provide calm, quiet and restful environment.
3. Provision of adequate fluid and nutrition.
• IV fluids are administered.
• Assess for return of bowel sounds.
• Oral feeding are started with glucose water or
electrolyte solutions, if baby starts tolerating breast
feeding can be started with frequent burping.
