PYLORIC
STENOSIS
CLASS:- B.Sc. Nursing 3rd year
PRESENTED BY:-
SHIKHA AWASTHI
Associate Professor
Child health nursing
.
DEFINITION
• It is the narrowing of the lower portion of the
stomach that prevents food from moving
from stomach to intestine.
• It is caused due to hyperplasia and
hypertrophy of circular muscles of the
stomach.
Due to enlargement (hypertrophy) of the
muscle surrounding this opening which spasms
when the stomach empties.
This condition causes severe projectile non-
bilious vomiting.
It most often occurs in the first few months of
life.
It more specifically labelled as infantile
hypertrophic pyloric stenosis.
The thickened pylorus is felt classically as an
olive-shaped mass in the middle upper part or
right upper quadrant of the infant's abdomen.
3/1000 live birth
Male: Female = 4:1
Commonly in the first born male child
Child of those parents who
affected with pyloric stenosis.
It affect more commonly child than the
adult.
causes
Premature birth: Pyloric stenosis is
more common in babies born
prematurely than in full-term babies.
Smoking during
pregnancy: This
behavior can
double the risk nearly
of
pyloric stenosis.
Early antibiotic use: Babies
given certain antibiotics in the
first weeks of life - erythromycin
to treat whooping cough, for
example - have an increased
risk of pyloric stenosis. In
addition, babies born to mothers
who took certain antibiotics in
late pregnancy also may have
an increased risk of pyloric
stenosis.
Bottle-feeding: Some studies suggest
that bottle-feeding rather than breast-
feeding can increase the risk of pyloric
stenosis.
A diffuse hypertrophy and hyperplasia of smooth
muscles of the pyloric sphincter
Narrowing of the pylorus with partial and then almost
complete obstruction
Stomach contents cannot flow through the constricted
pylorus
In an attempt to move the food forward
through obstruction, vigrous paristalsis occur
• Persistent vomiting and dilated stomach
musculature
• Develops dehydration, hypochloremic
alkalosis
CLINICAL FEATURES
• Signs
of pyloric
REGURGITATION stenosis usually
• appear withinVOMITING
NON-BILIOUS three to five weeks after
• birth.
PROJECTILE VOMITING
• HUNGRY INFANT
Pyloric stenosis is rare in babies older
• WEIGHT LOSS
than age 3 months. Signs and
• DEHYDRATION
symptoms include:
• REDUCED FREQUENCY AND AMOUNT OF
STOOLS
Vomiting after feeding. The baby may vomit
forcefully, ejecting breast milk or formula up
to several feet away (projectile vomiting).
Vomiting might be mild at first and gradually
become more severe as the pylorus opening
narrows. The vomit may sometimes contain
blood.
Persistent hunger. Babies who have
pyloric stenosis often want to eat soon
after vomiting.
Stomach contractions. Notice wave-
like contractions (peristalsis) that ripple
across baby's upper abdomen soon
after feeding, but before vomiting. This
is caused by stomach muscles trying
to force food through the narrowed
pylorus.
Dehydration. Baby might cry without
tears or become lethargic. You might
find yourself changing fewer wet
diapers or diapers that aren't as wet as
you expect.
Changes in bowel movements.
Since pyloric stenosis prevents food
from reaching the intestines, babies
with this condition might be
constipated.
Weight problems. Pyloric stenosis
can keep a baby from gaining weight,
and sometimes can cause weight loss.
Olive shaped mass “pyloric tumor” at
angle between right rectus muscle and
liver.
DIAGNOSTIC EVALUATION
• PHYSICAL EXAMINATION:- OLIVE SHAPED
MASS IN THE EPIGASTRIUM
• BARIUM STUDY:- FOR CONFIRMATION
• SHOW DELAYED EMPTYING OF GASTRIC
CONTENT
• BLOOD INVESTIGATIONS:- METABOLIC
ALKALOSIS
• HIGH URINE SPECIFIC GRAVITY
Infantile pyloric stenosis is
managed typically
with surgery; very few cases
are mild enough to be treated
medically.
The danger of pyloric stenosis comes
from the dehydration and electrolyte
disturbance rather than the underlying
problem itself.
Therefore, the baby must be initially
stabilized by correcting the
dehydration and the abnormally high
blood pH seen in combination with low
chloride levels with IV fluids. This can
usually be accomplished in about 24–
48 hours.
Intravenous and oral atropine may be
used to treat pyloric stenosis. It has a
success rate of 85-89% compared to
nearly 100% for pyloromyotomy,
however it requires prolonged
hospitalization, skilled nursing and careful
follow up during treatment.
It might be an alternative to surgery in
children who have contraindications for
anaesthesia or surgery, or in children
whose parents do not want surgery.
Laparoscopic pyloromyotomy
Fred-Ramstedt’s Pyloromyotomy
Consider thermoregulation at
all times,
Before transport to theatre,
transfer
infanttoincubatorsetatneutral
thermalenvironment (NTE)
temperature.
Ensure incubator will be plugged in
and pre-warmed for the infant to be
transferred into in recovery.
After to the ward, ensure
return
temperature is stable prior to
transferring to open cot.
Monitor temperature hourly until stable.
Routine post anaesthetic observations.
Monitor wound and report
abnormalities to surgeon.
Observe for bleeding, redness,
swelling, ooze from incision site.
Maintain adequate fluid balance chart.
Monitor IV site.
Ensureadequatepainrelief;usepain
assessment tool.
ASSIGNMENT
• Describe in detail about the post operative
nursing management of a pt. With pyloric
stenosis.
THANK YOU
