CONGENITAL HYPERTROPHIC PYLORIC STENOSIS

  • Hypertrophy of the musculature of pyloric antrum, especially the circular muscle fibres, causing failure of pylorus to relax. 
  • Duodenum is normal.

Pathophysiology
  • Progressive hypertrophy of the circular muscles in the pyloric sphincter.
  • Not present at birth but occurs over 3 to 5 weeks.

Clinical Features
  • Common in 1st born male child.
  • Projectile vomiting (non bile-stained fluid)
  • Weight loss, child becomes emaciated and dehydrated.
  • Hypertrophied pylorus is palpated in the epigastrium (“olive”). It’s mobile, smooth, firm mass with  well defined borders.
  • Visible gastric hyperperistalsis.

Visible gastric hyperperistalsis
Diagnosis
  •      Diagnosis can be made with test feed .
  •      USG is the investigation of choice- features present in the pyloric canal can be seen.


D/D
  •      GERD
  •      Feeding problems
  •      Raised ICP
  •      Duodenal atresia
  •      Intestinal obstruction

T/T

At first metabolic abnormalities should be corrected (i.e. dehydration with low Na+,Cl, K+ and metabolic alkalosis) with i.v dextrose, NS and K+.

Surgery
  • Ramstedt’s operation:
  • Laparotomy is done
  • Hypertrophied muscle is cut along the whole length until the mucosa bulges out. Mucosa should not be opened.

Duodenal Atresia
  • Atresia is distal to entry of the common bile duct (occurs at the point of fusion between the foregut and midgut)
  • Association with Down syndrome

  • History of maternal polyhydramnios (cannot reabsorb amniotic fluid)
  • Vomiting of bile-stained fluid at birth

     "Double bubble sign": air in stomach and air in proximal duodenum
  •      Antenatal diagnosis can be made-USG
T/T
  •      Duodenoduodenostomy

3 comments:

  1. mbbs in Philippines
    Every year, almost 8000 foreign students take admission in Philippines Medical universities and out of which around 50% are Indian students. The standard of education in Philippines universities is well known around the world. Thousands of doctors from these medical universities are sent to various countries like USA and UK every year. There are around 2299 higher educational institutions and 40 medical colleges. The main benefits of pursuing MD degree from

    Top Medical Colleges in Philippines :

    EMILIO AGUINALDO COLLEGE OF MEDICINE
    UNIVERSITY OF PERPETUAL HELP SYSTEM DALTA
    LYCEUM NORTHWESTERN UNIVERSITY
    DAVAO MEDICAL SCHOOL FOUNDATION
    SOUTHWESTERN UNIVERSITY

    Top Searched Topics on MBBS in Philippines


    study mbbs in philippines
    philippines medical colleges list
    best medical colleges in philippines for indian students
    philippines medical colleges
    best medical colleges in philippines
    mci approved medical colleges in philippines

    for more information contact us : +91 90329 55688

    ReplyDelete
  2. mbbs in Philippines
    Every year, almost 8000 foreign students take admission in Philippines Medical universities and out of which around 50% are Indian students. The standard of education in Philippines universities is well known around the world. Thousands of doctors from these medical universities are sent to various countries like USA and UK every year. There are around 2299 higher educational institutions and 40 medical colleges. The main benefits of pursuing MD degree from

    Top Medical Colleges in Philippines :

    EMILIO AGUINALDO COLLEGE OF MEDICINE
    UNIVERSITY OF PERPETUAL HELP SYSTEM DALTA
    LYCEUM NORTHWESTERN UNIVERSITY
    DAVAO MEDICAL SCHOOL FOUNDATION
    SOUTHWESTERN UNIVERSITY

    Top Searched Topics on MBBS in Philippines


    study mbbs in philippines
    philippines medical colleges list
    best medical colleges in philippines for indian students
    philippines medical colleges
    best medical colleges in philippines
    mci approved medical colleges in philippines

    for more information contact us : +91 90329 55688

    ReplyDelete
  3. UV GULLAS COLLEGE OF MEDICINE is one of Top Medical College in Philippines in Cebu city. International students have the oppertunity to study medicine in phillipines at affordable cost and world class University. The college has successful alumni who have achieved well in the fields of law, business, politics, academe, medicine, sports and other endeavors. At University of the Visayas, we prepare students for a global competition.

    Direct MBBS Admissions Open: 2020-21
    Mobile No: +91 90329 55688
    Apply Now: https://www.careerplus.org.in/philippines-medical-college/uv-gullas-college-of-medicine

    ReplyDelete

Popular Posts