Pyloric Stenosis

Pyloric stenosis is the idiopathic hypertrophy of smooth muscle of the pylorus that leads to gastric outlet obstruction in infants. Epidemiology is 1.7 to 2.4/1000 live births (incidence may be declining). Male:female ratio is 4: 1. Range of age at presentation is 2 to 26 weeks, with the median age of 6 weeks. It is most common in infants 2 to 4 months of age.

Causes

• Pyloric Stenosis may be caused by a thickening of the muscles of the pylorus.
• It is also occur due to maternal hormones in your body.
• Pyloric Stenosis may caused by the lack receptors in the pyloric muscle that detect nitric oxide, a chemical in the body that tells the pylorus muscle to relax.

Symptoms

• Vomiting described as nonbilious +++++. Median duration of vomiting before diagnosis is 7 days.
• An infant may appear hungry and feed vigorously between episodes unless, or until, he or she becomes severely dehydrated.

Signs

• Epigastric or right upper quadrant mass +++. The mass is more easily palpable by elevating the child's legs and palpating during a feed just after the stomach has been emptied.
• Volume depletion +++.

Treatment

• You can treat the pyloric stenosis with an operation. but, doctor may need to treat your baby's dehydration and mineral imbalances first. In which, water and minerals can be replaced through intravenous fluid. Once your baby is no longer dehydrated, then surgery can be performed. Under anesthesia, a small incision is made above the navel and the tight pyloric muscle is repaired.
• Another treatment is definitive treatment, in whcih pyloric stenosis is repair with surgical pyloromyotomy by dividing the muscle layer of the pylorus to open up the gastric outlet. Once the stomach can empty into the duodenum feeding can commence.
• You can also treat Pyloric Stenosis by barium swallow instead of an ultrasound. The baby swallows a small amount of a chalky liquid (barium), and then special X-rays are taken to view the pyloric region of the stomach to see if there is any narrowing or obstruction.