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{{Pyloric stenosis}}
{{Pyloric stenosis}}
{{CMG}} {{AE}} {{MMJ}}
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==Overview==
==Overview==
The symptoms of pyloric stenosis usually develop in the first days of life, and start with projectile [[Nausea and vomiting|vomiting]]. If left untreated, infants with mild infantile pyloric stenosis can develop severe [[Electrolyte imbalance|electrolyte imbalances]] include [[hypokalemia]] , [[hypochloremia]], and [[metabolic alkalosis]].In rare cases of untreated pyloric stenosis, patients may develop significant problems on the cognition, receptive language, fine motor, and gross motor skills compared to the normal infants due to long term [[malnutrition]]. Complications of infantile pyloric stenosis before surgery include vomiting and failure to gain weight in [[newborn]] period. Prognosis is generally excellent and [[surgery]] usually provides complete relief of symptoms. Infant<nowiki/>s usually tolerate small, frequent feedings several hours after [[surgery]]


The [[gastric outlet obstruction]] due to the hypertrophic pylorus impairs emptying of gastric contents into the [[duodenum]]. As a consequence, all ingested food and gastric secretions can only exit via [[Nausea and vomiting|vomiting]], which can be of a projectile nature. The vomited material does not contain [[bile]] because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the [[stomach]].
==Natural History, Complications, and Prognosis==
===Natural History===
* The symptoms of pyloric stenosis usually develop in the first days of life, and start with projectile [[Nausea and vomiting|vomiting]].
* If left untreated, infants with mild infantile pyloric stenosis can develop severe [[Electrolyte imbalance|electrolyte imbalances]] include [[hypokalemia]] , [[hypochloremia]], and [[metabolic alkalosis]].<ref name="pmid23528507">{{cite journal| author=Tutay GJ, Capraro G, Spirko B, Garb J, Smithline H| title=Electrolyte profile of pediatric patients with hypertrophic pyloric stenosis. | journal=Pediatr Emerg Care | year= 2013 | volume= 29 | issue= 4 | pages= 465-8 | pmid=23528507 | doi=10.1097/PEC.0b013e31828a3006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23528507  }} </ref>
* In rare cases of untreated pyloric stenosis, patients may develop significant problems on the cognition, receptive language, fine motor, and gross motor skills compared to the normal infants due to long term [[malnutrition]].<ref name="pmid21129547">{{cite journal| author=Walker K, Halliday R, Holland AJ, Karskens C, Badawi N| title=Early developmental outcome of infants with infantile hypertrophic pyloric stenosis. | journal=J Pediatr Surg | year= 2010 | volume= 45 | issue= 12 | pages= 2369-72 | pmid=21129547 | doi=10.1016/j.jpedsurg.2010.08.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21129547  }} </ref>


[[Vomiting]] after surgery is the most common complication of infantile hypertrophic pyloric stenosis. Failure to gain weight in the newborn ,[[Bleeding]] and [[Infection]] after [[surgery]] are the other [[Complication (medicine)|complications]] of infantile pyloric stenosis.
=== Complications ===
==Natural History==
*Complications of infantile pyloric stenosis before surgery include:<ref name="pmid23528507">{{cite journal| author=Tutay GJ, Capraro G, Spirko B, Garb J, Smithline H| title=Electrolyte profile of pediatric patients with hypertrophic pyloric stenosis. | journal=Pediatr Emerg Care | year= 2013 | volume= 29 | issue= 4 | pages= 465-8 | pmid=23528507 | doi=10.1097/PEC.0b013e31828a3006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23528507  }} </ref>
**[[Hypokalemia]]
**[[Hypochloremia]]
**[[Metabolic alkalosis]]


The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the [[duodenum]]. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature. The vomited material does not contain [[bile]] because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the stomach.
*Complications of infantile pyloric stenosis after surgical correction include:<ref name="pmid526031">{{cite journal| author=Spitz L| title=Vomiting after pyloromyotomy for infantile hypertrophic pyloric stenosis. | journal=Arch Dis Child | year= 1979 | volume= 54 | issue= 11 | pages= 886-9 | pmid=526031 | doi= | pmc=1545582 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=526031  }} </ref><ref name="pmid28928620">{{cite journal| author=Srivastava NT, Parent JJ, Schamberger MS| title=Consideration of pyloric stenosis as a cause of feeding dysfunction in children with cyanotic heart disease. | journal=Ann Pediatr Cardiol | year= 2017 | volume= 10 | issue= 3 | pages= 298-300 | pmid=28928620 | doi=10.4103/apc.APC_51_17 | pmc=5594945 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28928620  }} </ref><ref name="pmid28293079">{{cite journal| author=Romano C, Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG et al.| title=Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology. | journal=World J Gastroenterol | year= 2017 | volume= 23 | issue= 8 | pages= 1328-1337 | pmid=28293079 | doi=10.3748/wjg.v23.i8.1328 | pmc=5330817 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28293079  }} </ref>
** [[Vomiting]]: This is a very common complication after surgical correction and generally improves over time.
** Failure to gain weight in [[newborn]] period.
** Common complications of the [[surgery]] are :
*** [[Bleeding]]
*** [[Infection]]


This results in loss of gastric acid ([[hydrochloric acid]]). The [[chloride]] loss results in [[hypochloremia]] which impairs the kidney's ability to excrete bicarbonate. This is the significant factor that prevents correction of the alkalosis.<ref name="Acidbase">Kerry Brandis, [http://www.anaesthesiamcq.com/AcidBaseBook/ab7_3.php Acid-Base Physiology]. Retrieved December 31, 2006.</ref>
===Prognosis===


A secondary [[hyperaldosteronism]] develops due to the [[hypovolaemia]]. The high [[aldosterone]] levels causes the [[Kidney|kidneys]] to:
* Prognosis is generally excellent and [[surgery]] usually provides complete relief of symptoms. Infant<nowiki/>s usually tolerate small, frequent feedings several hours after [[surgery]].<ref name="pmid1127996">{{cite journal| author=Gibbs MK, Van Herrden JA, Lynn HB| title=Congenital hypertrophic pyloric stenosis. Surgical experience. | journal=Mayo Clin Proc | year= 1975 | volume= 50 | issue= 6 | pages= 312-6 | pmid=1127996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1127996  }} </ref>
*Avidly retain Na<sup>+</sup> (to correct the intravascular [[volume depletion]])
*Excrete increased amounts of K<sup>+</sup> into the [[urine]] (resulting in [[hypokalaemia]]).
The body's compensatory response to the [[metabolic alkalosis]] is [[hypoventilation]] resulting in an elevated arterial pCO<sub>2</sub>.
===Associated Conditions===
About 7% of babies will have other conditions such as [[intestinal malrotation]], [[urinary tract obstruction]], and [[esophageal atresia]].
==Complications==
* [[Vomiting]] after surgery -- this is very common and generally improves with time
* Failure to gain weight in the newborn period
* Risks associated with any surgery, which include:
** [[Bleeding]]
** [[Infection]]


==Prognosis==
* Up to 80% of patients continue to regurgitate even after surgical correction.<ref name="pmid1127996">{{cite journal| author=Gibbs MK, Van Herrden JA, Lynn HB| title=Congenital hypertrophic pyloric stenosis. Surgical experience. | journal=Mayo Clin Proc | year= 1975 | volume= 50 | issue= 6 | pages= 312-6 | pmid=1127996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1127996  }} </ref>


* Surgery usually provides complete relief of symptoms. The infant can usually tolerate small, frequent feedings several hours after surgery.
* As many as 80% of patients continue to regurgitate after surgery
* Patients who continue to vomit 5 days after surgery may warrant further radiologic investigation
==References==
==References==
{{Reflist|2}}{{WH}} {{WS}}
{{Reflist|2}}
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[[Category:Surgery]]
[[Category:Gastroenterology]]
[[Category:Disease]]
[[Category:Pediatrics]]
[[Category:Up-To-Date]]

Latest revision as of 19:56, 11 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

The symptoms of pyloric stenosis usually develop in the first days of life, and start with projectile vomiting. If left untreated, infants with mild infantile pyloric stenosis can develop severe electrolyte imbalances include hypokalemia , hypochloremia, and metabolic alkalosis.In rare cases of untreated pyloric stenosis, patients may develop significant problems on the cognition, receptive language, fine motor, and gross motor skills compared to the normal infants due to long term malnutrition. Complications of infantile pyloric stenosis before surgery include vomiting and failure to gain weight in newborn period. Prognosis is generally excellent and surgery usually provides complete relief of symptoms. Infants usually tolerate small, frequent feedings several hours after surgery

Natural History, Complications, and Prognosis

Natural History

  • The symptoms of pyloric stenosis usually develop in the first days of life, and start with projectile vomiting.
  • If left untreated, infants with mild infantile pyloric stenosis can develop severe electrolyte imbalances include hypokalemia , hypochloremia, and metabolic alkalosis.[1]
  • In rare cases of untreated pyloric stenosis, patients may develop significant problems on the cognition, receptive language, fine motor, and gross motor skills compared to the normal infants due to long term malnutrition.[2]

Complications

  • Complications of infantile pyloric stenosis after surgical correction include:[3][4][5]
    • Vomiting: This is a very common complication after surgical correction and generally improves over time.
    • Failure to gain weight in newborn period.
    • Common complications of the surgery are :

Prognosis

  • Prognosis is generally excellent and surgery usually provides complete relief of symptoms. Infants usually tolerate small, frequent feedings several hours after surgery.[6]
  • Up to 80% of patients continue to regurgitate even after surgical correction.[6]

References

  1. ↑ 1.0 1.1 Tutay GJ, Capraro G, Spirko B, Garb J, Smithline H (2013). "Electrolyte profile of pediatric patients with hypertrophic pyloric stenosis". Pediatr Emerg Care. 29 (4): 465–8. doi:10.1097/PEC.0b013e31828a3006. PMID 23528507.
  2. ↑ Walker K, Halliday R, Holland AJ, Karskens C, Badawi N (2010). "Early developmental outcome of infants with infantile hypertrophic pyloric stenosis". J Pediatr Surg. 45 (12): 2369–72. doi:10.1016/j.jpedsurg.2010.08.035. PMID 21129547.
  3. ↑ Spitz L (1979). "Vomiting after pyloromyotomy for infantile hypertrophic pyloric stenosis". Arch Dis Child. 54 (11): 886–9. PMC 1545582. PMID 526031.
  4. ↑ Srivastava NT, Parent JJ, Schamberger MS (2017). "Consideration of pyloric stenosis as a cause of feeding dysfunction in children with cyanotic heart disease". Ann Pediatr Cardiol. 10 (3): 298–300. doi:10.4103/apc.APC_51_17. PMC 5594945. PMID 28928620.
  5. ↑ Romano C, Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG; et al. (2017). "Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology". World J Gastroenterol. 23 (8): 1328–1337. doi:10.3748/wjg.v23.i8.1328. PMC 5330817. PMID 28293079.
  6. ↑ 6.0 6.1 Gibbs MK, Van Herrden JA, Lynn HB (1975). "Congenital hypertrophic pyloric stenosis. Surgical experience". Mayo Clin Proc. 50 (6): 312–6. PMID 1127996.

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