00:01
The topic is pyloric stenosis.
00:04
Before we move on,
please understand where the
pylorus is. Picture it.
00:09
You’re in the antrum of
the stomach and you’re
about to enter the first
part of the duodenum.
00:13
What then happens here is
the fact that the pylorus,
which is a smooth muscle,
technically it’s not
even a sphincter,
it’s a physiologic smooth
muscle hypertrophy
that may take place excessively
resulting in gastric
outlet obstruction.
00:32
So if there’s outlet obstruction,
you can’t get into the duodenum
what's the only direction
that this chime can move in?
Projectile vomiting.
00:42
And the vomit that you’re going
to experience or see here
is going to be non-bilious
because you haven’t connected
the common bile duct yet.
00:52
Risk factors:
Males, and we’re not
exactly sure why.
00:56
Usually first born,
it’s interesting.
00:59
And the ratio of males to females is 4:1.
01:02
So boys, much, much, much more so.
01:04
Look for family history
of pyloric stenosis.
01:08
Signs and symptoms: Non-bilious
projectile vomiting,
often after three weeks
of age in that boy.
01:16
The “happy vomiter” is
what they’re called
and may have palpable olive
in the right upper quadrant.
01:24
That’s where you’d
expect your pyloric --
or hypertrophic pylorus to be.
01:28
The definitive diagnosis is usually made by Ultrasound and will show a thickend elongated pylorus.
01:34
Aditionally an upper GI-series can show a dilated stomach with an elongated pylorus
and that is also a defended diagnostic method.
01:42
Here, supportive
therapy is important.
01:44
Hypokalemia, hyperchloremic,
metabolic alkalosis
might be a possibility
because of the vomiting.
01:52
Our management will
be supportive.
01:55
Remember, with pyloric
stenosis, you have a young boy
who’s vomiting quite a bit.
01:58
So with that vomit, remember, this
will be a metabolic alkalosis.
02:02
And with that vomiting
taking place,
you might be worried about
potassium and,
well, electrolyte disturbances.
02:10
Once the supportive therapy has stabilized the patient
Ultimately surgical correction is necessary.