Pyloric Stenosis

Last Updated on by FRCEM Intermediate

Overview

  • diffuse hypertrophy and hyperplasia of the smooth muscle of the antrum of the stomach and pylorus. results in narrowing of the pyloric canal, which can then easily become obstructed.
  • occurs in infants aged 2 – 8 weeks.
  • common in males than in females.

Clinical feature

  • projectile vomiting in neonate (not billous)-normally occurs 30 – 60 minutes after a feed, with the baby
  • remaining hungry
  • 2-8 weeks
  • dehydration
  • weight loss
  • lethargy
  • infrequent/absent bowel movements may be seen.
  • An enlarged pylorus, classically described as an ‘olive’, may be palpated in the right upper quadrant or epigastrium of the abdomen.

Investigations

  • Biochemistry: there is often hypochloraemic metabolic alkalosis with severe potassium depletion
  • Ultrasound abdomen

Management

  • correction of fluid deficiency and electrolyte imbalance
  • Surgical correction (pyloromyotomy)

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