What is Pyloric Stenosis?
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Pyloric stenosis is a condition in infants where hypertrophy of the pyloric muscle leads to gastric outlet obstruction. It typically presents in the first few weeks of life and requires prompt diagnosis and surgical management.
Epidemiology
- Incidence: ~2-4 per 1000 live births
- Male-to-female ratio: 4:1
- Most common in first-born males
- Rare beyond 12 weeks of age
Clinical Features
- Projectile, non-bilious vomiting after feeds
- Onset usually between 2–6 weeks of age
- Infant remains hungry after vomiting
- Weight loss or poor weight gain
- Dehydration, visible peristalsis
- Palpable “olive-shaped” mass in the right upper quadrant
Differential Diagnosis
- Gastro-oesophageal reflux
- Cow’s milk protein allergy
- Gastroenteritis
- Metabolic disorders
- Sepsis
Investigations
- Clinical diagnosis if mass is palpable
- Ultrasound is the investigation of choice
- Shows elongated pyloric canal and thickened pyloric muscle
- Bloods may show:
- Hypochloraemic, hypokalaemic metabolic alkalosis
Management
- Initial: IV fluids and electrolyte correction
- Definitive: Ramstedt pyloromyotomy (surgical)
- Prognosis is excellent after surgery
Referral
- Immediate paediatric surgical referral once suspected
- Early recognition is crucial to prevent complications from dehydration and electrolyte imbalance