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Encyclopedia > Pyloric stenosis
Pyloric stenosis
Classifications and external resources
Outline of stomach, showing its anatomical landmarks.
ICD-10 K31.1, Q40.0
ICD-9 537.0, 750.5
DiseasesDB 11060 29488
MedlinePlus 000970
eMedicine emerg/397  radio/358
MeSH D046248

Infantile pyloric stenosis is a pediatric condition where there is a congenital narrowing of the pylorus (the opening at the lower end of the stomach). Males are more commonly affected than females, and there is a genetic predisposition for the disease. It is uncertain whether there is a real congenital narrowing or whether there is a functional hypertrophy of the muscle which develops in the first few weeks of life. Image File history File links Gray1046. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... // Q00-Q99 - Congenital malformations, deformations and chromosomal abnormalities (Q00-Q07) Congenital malformations of the nervous system (Q00) Anencephaly and similar malformations (Q01) Encephalocele (Q02) Microcephaly (Q03) Congenital hydrocephalus (Q04) Other congenital malformations of brain (Q05) Spina bifida (Q06) Other congenital malformations of spinal cord (Q07) Other congenital malformations of nervous... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Diseases Database is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... From Greek pylorus; pyl- = gate, -orus = guard. ... In anatomy, the stomach (in ancient Greek στόμαχος) is an organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ...


(Note: Pyloric stenosis also occurs in adults where the cause is usually a narrowed pylorus due to scarring from chronic peptic ulceration. This is a different condition from infantile hypertrophic pyloric stenosis.)

Contents

Symptoms

Babies with this condition usually present within the first few weeks (usually between 2nd and 3rd, although there can be significant variability) with progressively worsening vomiting. The vomiting is often described as "projectile vomiting." Some infants present with poor feeding and weight loss, but others demonstrate normal weight gain. Dysphagia should not be confused with the similarly pronounced dysphasia, a speech disorder. ... Weight loss, in the context of medicine or health, is a reduction of the total body weight, which occurs when the body loses fluid, muscle mass, or fat. ...


Diagnosis

Diagnosis is via a careful history and physical examination. Palpation of the abdomen during a test feed may reveal a mass in the epigastrium consisting of the enlarged pylorus (pyloric tumour) with palpable (indeed, sometimes visible) peristaltic waves consisting of the stomach trying to force its contents past the narrowed pylorus. Palpation is a method of examination in which the examiner feels the size or shape or firmness or location of something (of body parts when the examiner is a health professional). ... The epigastrium is the upper central region of the abdomen. ... Peristalsis is the process of involuntary wave-like successive muscular contractions by which food is moved through the digestive tract. ...


Blood tests will reveal hypochloremic alkalosis secondary to loss of acidic gastric secretions due to persistent vomiting. Alkalosis refers to a condition reducing hydrogen ion concentration of arterial blood plasma. ... Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ...


In the U.S., most cases of pyloric stenosis are diagnosed via ultrasound. Ultrasound examination will show hypertrophied pyloric musculature, sometimes greater than 4 mm. A fetus in its mothers womb, viewed in a sonogram (brightness scan) A fetus, aged 29 weeks, in a 3D ultrasound Ultrasound is sound with a frequency greater than the upper limit of human hearing, this limit being approximately 20 kilohertz (20,000 hertz). ...


Pathophysiology

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. In anatomy of the digestive system, the duodenum is a hollow jointed tube connecting the stomach to the jejunum. ... Bile (or gall) is a bitter, greenish-yellow alkaline fluid secreted by hepatocytes from the liver of most vertebrates. ...


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. [1]. The chemical compound hydrochloric acid is the aqueous (water-based) solution of hydrogen chloride (HCl). ... The chloride ion is formed when the element chlorine picks up one electron to form an anion (negatively-charged ion) Cl−. The salts of hydrochloric acid HCl contain chloride ions and are also called chlorides. ... Hypochloremia is an electrolyte disturbance in which there is an abnormally depleted level of the chloride ion in the blood. ...


A secondary hyperaldosteronism develops due to the hypovolaemia. The high aldosterone levels causes the kidneys to: In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. ... Aldosterone is a steroid hormone synthesized from cholesterol by the enzyme aldosterone synthase. ...

  • avidly retain Na+ (to correct the intravascular volume depletion)
  • excrete increased amounts of K+ into the urine (resulting in hypokalaemia).

The body's compensatory response to the metabolic alkalosis is hypoventilation resulting in an elevated arterial pCO2. Hypokalemia is a condition in which the body fails to retain sufficient potassium to maintain health. ...


Treatment

Pyloromyotomy scar (rather large) 30 hrs post-op in a 1 month-old baby
Pyloromyotomy scar (rather large) 30 hrs post-op in a 1 month-old baby

Infantile pyloric stenosis is not a surgical emergency, but if not surgically corrected, the infant will die of malnutrition and dehydration. Image File history File links Download high-resolution version (743x703, 43 KB) by ST File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Pyloric stenosis ... Image File history File links Download high-resolution version (743x703, 43 KB) by ST File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Pyloric stenosis ...


Initially the baby's condition must be improved by correcting the dehydration and hypochloremic alkalosis with IV fluids. This can usually be accomplished in about 24-48 hours. Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ... Alkalosis refers to a condition reducing hydrogen ion concentration of arterial blood plasma. ...


Definitive treatment of pyloric stenosis is with surgical pyloromyotomy - dividing of the muscle layer of the pylorus to open up the gastric outlet (distal opening of the stomach). Once the stomach can empty into the duodenum feeding can commence. A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ... It has been suggested that this article or section be merged into Muscular system. ... From Greek pylorus; pyl- = gate, -orus = guard. ... In anatomy, the stomach (in ancient Greek στόμαχος) is an organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube connecting the stomach to the jejunum. ...


Reference

  • Hulka F, Campbell TJ, Campbell JR, Harrison MW. Evolution in the recognition of infantile hypertrophic pyloric stenosis. Pediatrics 1997;100(2):E9. Fulltext. PMID 9233980.

External links


  Results from FactBites:
 
CIGNA - Pyloric Stenosis (1242 words)
Pyloric stenosis is a condition in which a baby's pylorus gradually swells and thickens, which interferes with food entering the intestine.
Pyloric stenosis is diagnosed by a physical examination and your baby's medical history and symptoms.
Pyloric stenosis and congenital anomalies of the stomach.
Digestive and Liver Disorders - Pyloric Stenosis (919 words)
Pyloric stenosis is a problem that affects babies between 2 and 8 weeks of age and causes forceful vomiting that can lead to dehydration.
Pyloric stenosis (PS) is considered a "multifactorial trait." Multifactorial inheritance means that "many factors" (multifactorial) are involved in causing a birth defect.
Pyloric stenosis may be inherited; several members of a family may have had this problem in infancy.
  More results at FactBites »

 
 

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