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Pyloric Stenosis

This is a condition where there's hypertrophy and narrowing of the pylorus, therefore preventing food from entering the duodenum. It typically presents in the first 6-8 weeks of life.

“Drawing showing pyloric stenosis before and after surgery” © BruceBlaus CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Presentation

  • Projectile vomiting (i.e. spurting over 1m away) that's non-bilious

    • After feeding, there’s powerful peristalsis to try and force the stomach contents into the duodenum. But, as the pylorus is very narrow, the contents eject backwards into the oesophagus and out the mouth.

  • Failure to thrive if left untreated


O/E - Firm, round olive-shaped mass


Investigations

  • Ultrasound

  • Blood gas - If severe, this will show hypochloremic hypokalaemic metabolic alkalosis (low Cl- due to loss of acid)

“Pyloric stenosis as seen on ultrasound in a 6 week old” © Dr Laughlin Dawes CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Management

  • NBM, IVF

  • Pyloromyotomy – Incision made in the smooth muscle of the pylorus to widen its opening

“Drawing showing pyloric stenosis before and after surgery” © BruceBlaus CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)


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