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HYPERTROPHIC PYLORICSTENOSISMohammad Damseh
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• Introduction
• Pathophysiology
• Signs and symptoms
• Diagnosis
• Treatment
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• It is a disease of early infancy - Affects a very limited age group 3-6 weeks. It rarely affects a childmore than 2 months of younger than 3 weeks of age. We can find atypical cases under the age of 3weeks or more than 6 weeks
• hypertrophy of the pyloric muscles and this hypertrophy causes pyloric obstruction.
• Male: female ratio is 4-6:1
• Overall incidence: 3/1000 live births.
• It is one of the most common surgical conditions in the west, so there is a strong racial variation
• There are genetic factors’ - tendency increases if the mother is affected more than if the father Isaffected
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Pathophysiology:
� Hypertrophy of the smooth muscles of the antrum due to unknown reasons. This causesnarrowing of the pyloric canal, which becomes easily obstructed.
• Vigorous peristalsis• Hypertrophy of the stomach• Gastritis, hematemesis, dehydration
• The end result is hypokalemic hypochloremic metabolic alkalosis andparadoxical acidurea.
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o How did the pathophysiology come into being?
• Failure of relaxation, which results in spasms• Abnormal ganglia were found in some cases, but not all of them• Deregulation of the VIP, nitric oxides, and polypeptides of the GIT.
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symptoms:• Progressive, persistent, projectile, non-bilious vomiting. - The baby is usually hungry after vomiting• Constipation is typical• Gastritis due to prolonged vomiting and hematemesis, which will lead to anemia due to chronic loss
of blood.
Signs▪ Olive sign: the enlarged pyloric canal is felt during physical
examination like an olive to the right of the vertebral columnjust below the liver.
▪ Succusion splash: After ingestion of fluids, the patient’sstomach will produce audible sounds
when moving the patient▪ Visible peristalsis: you may see peristaltic waves of the stomach
from left to right..
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Diagnosis:
• Typical clinical picture in 90% of the patients.
• Ultrasound
• Barium swallow
• Serum electrolytes, CBC, and pH
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Abdominal ultrasound: Confirms diagnosis with 95% sensitivity
Criteria for diagnosis:
Pyloric length : 3-4mm Pyloric length : 15-19mm
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Barium meal
Elongated narrowpyloric Canal “stringsign”
Parallel streaks of bariumseen in the narrowedchannel “double tractsign”
Bulge of pyloric muscle intoantrum “shoulder sign”
Markedly dilated stomach
Mushroom sign
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• Hypokalemia Hyperchloremic metabolic alkalosis• Hyponatremia
Serum electrolytes, CBC, and pH
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Treatment
Medical treatment
• correct dehydration and acid base imbalances.• Antispasmodic before feeds• Small, thick, frequent feeds• Keep upright for 1 hour after feeding
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Surgical treatment
• Ramsted’s pyloromyotomy
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Thank you