Description

Pyloric stenosis (foot-LOHR-ik stuh-NOH-sis) is a narrowing of the opening between the stomach and the small intestine. This uncommon condition in infants may trap food in the stomach.

Normally, a ring-shaped muscle of the valve closes to keep food in the stomach or opens to allow the food to pass into the small intestine. With pyloric stenosis, the muscle tissue is enlarged. The opening is very narrow, and little or no food passes through the intestine.

Pyloric stenosis usually leads to forceful vomiting, dehydration, poor nutrition, and weight loss. Babies with pyloric stenosis may seem to be hungry all the time.

Pyloric stenosis is treated with surgery.

The passage between the stomach and the small intestine is called the pylorus. The valve that controls the opening can be called the pyloric muscle pyloric sphincter or pyloric valve.

The enlargement of the pyloric muscle is called hypertrophy. Pyloric stenosis is also called hypertrophic pyloric stenosis.

Symptoms

The symptoms of pyloric stenosis usually appear within 3 to 6 weeks after the birth. Pyloric stenosis is rare in infants older than 3 months.

The symptoms include:

  • Vomiting after feeding. The baby vomits forcefully, extraction of breast milk or formula up to several feet away. This is known as projectile vomiting. The vomiting usually happens right after the feeding. Vomiting may be mild at first and get worse with time.
  • The constant hunger. Babies with pyloric stenosis often want to eat soon after vomiting.
  • Contractions of the stomach. Wavelike ripples across its abdomen, the baby can be visible after feeding, but before vomiting. This is a sign of stomach muscles trying to move food from the stomach.
  • The dehydration. A baby may show signs of low fluids of the body, also called dehydration. These signs can include a few wet diapers, lack of energy, dry mouth and lips, and crying without tears.
  • Changes in stool. From the pyloric stenosis prevents food from reaching the intestines, babies with this condition may be constipated.
  • The loss of weight. The lack of nutrition can cause the baby does not gain weight or lose weight.

When to see a doctor

Other conditions have symptoms such as pyloric stenosis. It is important to get a prompt and accurate diagnosis. See your baby's doctor if your baby:

  • Projectile vomiting after feeding.
  • It is hungry again immediately after vomiting.
  • It seems to be less active or unusually irritable.
  • You have a wet or dirty diapers.
  • Is not gaining weight or weight loss.

Causes

The causes of pyloric stenosis are unknown, but genes and environmental factors may play a role. Pyloric stenosis usually is not present at birth but develops later.

Risk factors

Pylorid stenosis is not a common condition. It is more likely that the babies:

  • Are the children.
  • They are the first born of the children.
  • They were born prematurely.
  • Have a family history of pyloric stenosis.
  • We were born to a cigarette smoker.
  • Were exposed to certain antibiotics late in pregnancy or after birth.
  • Are bottle-fed.

Complications

Pyloric stenosis can lead to:

  • Failure to grow and develop. The lack of nutrition causes poor growth, weight gain and development.
  • The dehydration. Frequent vomiting can cause low levels of fluid, called dehydration. This condition can also result in an imbalance in minerals called electrolytes. These minerals help regulate important functions in the body.
  • Jaundice. Rarely, a substance secreted by the liver, called bilirubin can accumulate. This can cause yellowing of the skin and of the whites of the eyes. This condition is called jaundice.

Diagnosis

Your baby's healthcare provider will ask about your symptoms and do a physical exam.

Sometimes, an olive in the form of a lump can be felt in the abdomen of the baby. This bundle is the enlargement of the muscle pyloric. This is more common in the later stages of the disease.

Wavelike contractions can sometimes be visible when looking at the baby's abdomen, especially after eating or before vomiting.

Imaging tests

Imaging tests may be used to diagnose pyloric stenosis or rule out other conditions. These tests include:

  • Ultrasound. The standard tool of diagnosis of pyloric stenosis is an ultrasound test. This is usually a simple test is performed with a device that is placed over the baby's belly. The image of the ultrasound may show enlargement of the pyloric valve.
  • X-ray: specialized X-ray exam may create a short video from the stomach into the action. A special liquid to feed the baby is visible as it comes in and goes out — or you try to leave — the stomach. This test is used less often than the ultrasound.

Blood tests

Your healthcare provider may order blood tests. The results may show signs of electrolyte imbalances and dehydration.

Treatment

Surgery is needed for the treatment of pyloric stenosis. Before the surgery, fluids and electrolytes are given through a tube placed in a vein. Proper hydration and electrolyte balance are required before the procedure. This may take 24 to 48 hours.

The procedure is called a pyloromyotomy. In pyloromyotomy, the surgeon cuts into the thickened muscle of the pyloric valve. Then, a device that is used to spread the muscle of the distance to the lining of the stomach tissue.

The muscle pyloric function, but this gap relaxes the muscle and allows food to move out of the stomach. The lining of the stomach will bulge in the open space, but the contents of the stomach does not escape.

Most of the time, surgery is performed through three small openings in the womb. Using a video camera, and two for the surgical instruments. This is called laparoscopic surgery. In some cases, a doctor will do an open surgery through a larger opening. Laparoscopic surgery generally has a shorter recovery time.

After the surgery:

  • Your baby will be carefully monitored for at least 24 hours.
  • Recommendations for food after the surgery may vary. In most cases, the feeding may begin 12 to 24 hours after the procedure.
  • Your health care team may recommend feeding when your baby is hungry, or they can recommend a program.
  • Some vomiting may occur after the surgery.
  • During the follow-up appointment, your care team will check your baby's weight, growth and development.

Possible complications of pyloric stenosis surgery are bleeding and infection. However, complications are not common, and the results of surgery are generally excellent.

Treatment option

Rarely, if a baby has a very high risk for surgery, the drug can be used for the treatment of pyloric stenosis. A drug called atropine sulfate can help to relax the pyloric muscle tissue.

This treatment is not as effective and required longer stays in the hospital for the surgery.

Preparing for your appointment

Your child's primary health care professional is likely to make the examination and make a diagnosis, but you may be referred to a specialist in digestive disorders called a gastroenterologist. If the diagnosis of pyloric stenosis, you will be referred to a pediatric surgeon.

What you can do

  • Write your baby's symptoms, including when and how often your baby is vomiting, if vomiting is projected with force, and if the vomiting appears to be more or only a part of what the baby has eaten.
  • Write questions to ask their health professional.

Questions to ask your doctor

  • What is the most likely cause of my baby's symptoms?
  • What tests does my baby need? Does not require special preparation?
  • Does my baby need surgery?
  • Will there be any food restrictions after surgery?

In addition to the questions you have prepared, do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your healthcare provider is likely to ask you a few questions. Be prepared to answer them you can let go the more points you want to spend more time. You may ask:

  • When he made his first baby begins to experience the symptoms?
  • The symptoms are continuous or occasional? Occur only after eating?
  • Is your baby hungry after vomiting?
  • Does the vomit comes out with force, leaving his baby shirt or a bib mostly dry?
  • What color is vomiting?
  • How many wet diapers does your baby have a day?
  • There is blood in the stool of the baby?
  • What was your baby's last recorded weight?
Symptoms and treatment of Pyloric stenosis