Pyloric Stenosis

last authored: Oct 2009, David LaPierre

 

Introduction

Pyloric stenosis has an incidence of 1:500, and is more common in males

10% genetically inherited

 

 

 

The Case of...

a simple case introducing clincial presentation and calling for a differential diagnosis. To get students thinking.

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Causes and Risk Factors

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Pathophysiology

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Signs and Symptoms

  • history
  • physical exam

History

Symptoms usually arise at 2-4 weeks of age, and are characterized by:

  • non-bilious projective vomiting after feeding
  • constipation
  • alert infant, willing to feed

Physical Exam

The three P's

Palpable mass

Peristalsis

Projectile vomiting

  • failure to thrive, wasting
  • dehydration
  • jaundice
  • gastric peristalsis traveling from LUQ to epigastrium
  • 'olive sign': olive-shaped mass in centre abdomen

 

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

hypochloremic metabolic acidosis

Diagnostic Imaging

Ultrasound is the modality of diagnostic choice

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Differential Diagnosis

Other causes of vomiting or failure to thrive should be considered.

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Treatments

Correct dehydration first; then go to the OR to avoid complications.

 

Can be done via lapasoscopy.

Slice muscle along stomach; keep submucosa intact

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Consequences and Course

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The Case of...

Case #2 - a small story wrapping it all up and asking about esp management.

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Additional Resources

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Topic Development

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