Hallmark is non-bilious vomiting. Other signs includ - PowerPoint PPT Presentation

Loading...

PPT – Hallmark is non-bilious vomiting. Other signs includ PowerPoint presentation | free to download - id: 13f97-Njc0O



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Hallmark is non-bilious vomiting. Other signs includ

Description:

Hallmark is non-bilious vomiting. Other signs include abdominal distention and bleeding from secondary inflammation ... First described by Hirschsprung in 1888 ... – PowerPoint PPT presentation

Number of Views:560
Avg rating:3.0/5.0
Slides: 18
Provided by: adripe
Learn more at: http://www.utmb.edu
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Hallmark is non-bilious vomiting. Other signs includ


1
Pyloric Stenosis
  • Adri Smith, M.D.
  • August 4, 2004

2
Gastric Outlet Obstruction
  • Hallmark is non-bilious vomiting
  • Other signs include abdominal distention and
    bleeding from secondary inflammation
  • Most common cause of non-bilious vomiting is
    infantile hypertrophic pyloric stenosis

3
Pyloric Stenosis
  • First described by Hirschsprung in 1888
  • Ramstedt described an operative procedure to
    alleviate the condition in 1907 the procedure
    used to this day to treat pyloric stenosis

4
Pyloric Stenosis
  • 3/1000 live births frequency may be increasing
  • Most common in whites of Northern European
    ancestry, less common in African Americans and
    rare in Asians
  • Four times more common in males especially
    firstborn
  • Increased in infants with type B or O blood
    groups
  • Associated with other congenital defects incl TEF

5
Etiology
  • Cause is unknown, but abnormal muscle
    innervation, breast feeding and maternal stress
    in the 3rd trimester have been implicated
  • Elevated serum PGs, reduced levels of pyloric
    nitric oxide synthase and infant hypergastrinemia
    have been found

6
Clinical Manifestations
  • Non-bilious vomiting is the initial symptom
  • May or may not be projectile initially
  • Usually progressive, occurs immediately after a
    feeding
  • Vomiting usually starts after 3 wks of age, but
    may develop as early as 1st week and as late as
    the 5th month

7
Clinical Manifestations
  • After vomiting, infant is hungry and wants to
    feed again
  • Progressive loss of fluid, hydrogen ion and
    chloride leads to a hypochloremic metabolic
    alkalosis.
  • Serum K levels are maintained
  • Greater awareness has led to earlier diagnosis

8
Clinical Manifestations
  • Jaundice occurs in 5 of infants with pyloric
    stenosis associated with a decreased level of
    glucuronyl transferase

9
Clinical Manifestations
  • Diagnosis traditionally made by palpation of mass
  • Firm, movable, approx 2 cm in length, olive
    shaped and best palpated from the left
  • Mass located above and to the right of the
    umbilicus in the midepigastrum beneath the liver
    edge
  • Peristaltic wave may be present prior to emesis

10
Diagnosis
  • Straightforward if olive is present
  • Difficult to distinguish from GERD esp in early
    stages
  • UGI or US can be used but US has become the
    standard at most centers
  • Ultrasound Sensitivity of 90
  • Criteria for diagnosis pyloric muscle thickness
    greater than 4 mm and an overall pyloric muscle
    length greater than 14mm

11
Diagnosis
  • US pitfalls pylorospasm may mimic those of PS,
    potential false-pos and false-negative readings
  • UGI classic signs are elongated pyloric canal,
    the double tract sign (parallel streaks of
    barium in the narrowed channel, and the shoulder
    sign(bulge of pyloric muscle into the antrum).
  • Main pitfall of UGI is radiation exposure

12
Differential
  • Infants who are reactive to external stimulation,
    those fed by inexperienced caretakers, or those
    for whom adequate maternal-infant bonding has not
    been established may vomit frequently in the
    early weeks of life.
  • GERD with or without a hiatal hernia may be
    confused with PS esp in the early stages

13
Differential
  • Inborn errors of metabolism may produce recurrent
    emesis with alkalosis or acidosis and lethargy,
    coma or seizures.
  • Salt-losing CAH presents with prominent vomiting
    shortly after birth. Females will be virilized,
    but the genitals appear normal in males.
    Acidosis and hyperkalemia usually present.

14
Differential
  • Vomiting with diarrhea suggests gastroenteritis.
  • Always have to think of increased ICP, subdural
    hematoma
  • Systemic infections can also cause persistent
    vomiting.

15
Treatment
  • Preoperative treatment is directed toward
    correcting the fluid/acid-base and electrolyte
    imbalances.
  • Correction of the alkalosis is essential to
    prevent postoperative apnea
  • Surgery is the treatment of choice Ramstedt
    pyloromyotomy

16
Treatment
  • Ramstedt pyloromyotomy performed through a
    short transverse incision or laparoscopically
  • Underlying pyloric mass is split without cutting
    the mucosa and the incision is closed
  • Post-op vomiting occurs in ½ the patients and
    thought to be due to edema of the pylorus
  • Feedings can usually be initiated within 12-24
    hours

17
Treatment
  • Persistent vomiting suggests an incomplete
    pyloromyotomy, gastritis, GERD.
  • Surgical treatment is curative with a low
    mortality rate
About PowerShow.com