PYLORIC STENOSIS

TYPES

There is only one type of pyloric stenosis, which is known as idiopathic hypertrophic pyloric stenosis (IHPS). Idiopathic means that the cause is unknown, and hypertrophic refers to the thickening of the pyloric muscle, leading to narrowing of the passageway between the stomach and the small intestine. IHPS is the most common cause of pyloric stenosis in infants and typically occurs within the first few weeks after birth.

While there is only one type of pyloric stenosis, the severity of the condition can vary from mild to severe. The degree of narrowing in the pyloric muscle can affect the severity of symptoms and the necessary treatment approach. However, regardless of the severity, the treatment for pyloric stenosis typically involves a surgical procedure called pyloromyotomy.

SYMPTOMS

The symptoms of pyloric stenosis typically become apparent within the first few weeks of an infant’s life. Here are some common symptoms associated with pyloric stenosis:

1. Projectile vomiting: This is the primary symptom of pyloric stenosis. The vomit is often forceful and shoots out in a projectile manner. It typically occurs shortly after feeding and may contain partially digested milk.

2. Poor weight gain: Due to the narrowing of the pylorus, the passage of food from the stomach to the intestines is restricted. This can lead to inadequate nutrition absorption and poor weight gain in infants.

3. Constant hunger despite frequent feeding: Infants with pyloric stenosis may continue to show signs of hunger despite frequent feeding. This is because the narrowed pylorus prevents food from entering the intestines efficiently, leaving the infant feeling unsatisfied.

4. Abdominal swelling or firmness: The abdomen may appear swollen or feel firm to the touch. This is due to the accumulation of undigested food in the stomach.

5. Decreased urine output: Pyloric stenosis can lead to dehydration, resulting in reduced urine output and fewer wet diapers.

DIAGNOSIS

The diagnosis of pyloric stenosis is typically made by a healthcare professional based on a combination of the infant’s medical history, physical examination, and diagnostic tests. Here are some common diagnostic methods used for pyloric stenosis:

1. Physical examination: The healthcare provider will perform a thorough physical examination, paying particular attention to the abdomen. They may feel for a small, hard mass in the upper abdomen, which can indicate an enlarged pylorus.

2. Ultrasound: An abdominal ultrasound is a commonly used imaging test to diagnose pyloric stenosis. It allows the healthcare provider to visualize the thickness of the pylorus and measure its length and width.

3. Blood tests: Blood tests may be done to evaluate the infant’s electrolyte levels, as pyloric stenosis can lead to imbalances due to repeated vomiting.

4. Upper gastrointestinal series: In some cases, an upper gastrointestinal (GI) series may be ordered. This involves the infant swallowing a contrast material, followed by x-rays to track the flow of the contrast through the digestive system. This can help confirm the diagnosis of pyloric stenosis.

Based on the results of these tests, the healthcare provider can make a definitive diagnosis of pyloric stenosis. Prompt diagnosis is important to ensure timely treatment and management of the condition. If you suspect your infant may have pyloric stenosis, it is best to consult with a healthcare professional for a proper evaluation.

TREATMENT

The primary treatment for pyloric stenosis is surgery, specifically a procedure called pyloromyotomy. Pyloromyotomy is a surgical intervention that aims to widen the pylorus, the muscular valve between the stomach and the small intestine, to allow for proper passage of food. Here is an overview of the treatment process for pyloric stenosis:

1. Preoperative preparation: Before the surgery, your healthcare team will provide instructions on how to prepare your infant for the procedure. This may involve fasting for a certain period of time before the surgery.

2. Surgery: Pyloromyotomy is typically performed under general anesthesia. During the procedure, a small incision is made in the abdomen, and the surgeon carefully cuts and spreads the thickened muscles of the pylorus to create a wider opening. This allows food to pass through more easily.

3. Recovery and postoperative care: Following the surgery, your infant will be monitored in a recovery area until they wake up from anesthesia. They may be given fluids intravenously initially and gradually transitioned to oral feeding. The healthcare team will provide instructions on feeding and caring for your infant post-surgery.

4. Follow-up care: Regular follow-up appointments will be scheduled to monitor your infant’s healing and progress. The healthcare provider will assess weight gain, feeding tolerance, and overall wellbeing.

Surgery for pyloric stenosis is highly successful, and most infants experience significant improvement in their symptoms after the procedure. It is important to follow the postoperative care instructions provided by your healthcare team to ensure a smooth recovery. If you have any concerns or questions, do not hesitate to reach out to your healthcare provider.