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Pyloric stenosis (Clinical
presentation (Vomiting
Occurs after feeds
…
Pyloric stenosis
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Diagnosis
Examination
Abdo exam
Visible peristalsis, may be distended
RUQ pyloric mass (feels like an olive),
signs of dehydration
Investigation
Bloods
cap blood gas (hypo-Cl- metabolic alkalosis, low Na, low K+),
FBC, U+E (deranged electrolytes), LFTs
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History
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FH
Pyloric stenosis, GIT disorders
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POH
Scans, growth, bloods, gestation,
delivery, weight, complications
PC/HPC
Vomiting: since birth/shortly after, initially normal then projectile, non-bilious, straight after feed, inc severity (freq and volume)
Associated symptoms: poor feeding, weight loss
No diarrhea, may have constipation (dehydration)
SH
Living arrangements, social support
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Management
Definitive
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Surgery
Pyloromyotomy
Indication: once stable
MOA: NG tube beforehand; division of hypertrophied
pyloric muscle; open laparotomy or laporoscopy
NB feed after 6h, discharge 2d
Conservative
Information, advice, support
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Pathophysiology
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Mechanism
Gastric outlet obstruction, causing vomiting
Vomiting is non-bilous as obstruction is high in the GIT (occurs before the entry of CBD in duodenum)
Loss of H+ and Cl- leads to hypo-Cl- metabolic alkalosis, low K+ and Na+
Definition
Developmental disorder of the
GIT, with hypertrophy of the pylorus
and gastric outflow obstruction