Definition of "Pyloric stenosis"

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Pyloric stenosis is stenosis (narrowing) of the pylorus (meaning "gate", i..e the muscle surrounding the opening from the stomach to the duodenum).

Patient information

I know that pyloric stenosis means "stenosis" of the "pylorus". But what does this mean in simple language?
It's narrowing of a muscle which you can find at that point of your GI tract, that is immediately after the stomach.

Sx
  • Severe projectile vomiting
  • Vomit is non-bilious

Patient information

Wait. So this means that food gets to the tummy. But it can't go any further, right? So you're going to get vomiting of all the stomach's contents?
That's correct! So you get vomiting.

What does it mean that the vomiting is "non-bilious" though?
It means that there's no bile in the vomit. Bile is detergent that can help flush out fats from your body. It is produced in the liver, stored in the gallbladder, and released into the small intestine - that's found after the stomach. So because there is a narrowing of the muscle right after the stomach - before it gets to the small intestine, you aren't going to see any bile come up. That's why it's "non-bilious".

I see. Why is this vomiting considered "projectile"?
Just imagine if you have a constriction after the stomach. You won't be able to do number 2's. Everything can only come back out out of the mouth. Because it can only exit the stomach by vomting, it's going to be very high pressure. That causes the vomiting to be "projectile".

Pathophysiology
  • Hypertrophy of the pylorus, which spasms when the stomach empties
  • In babies, it is uncertain whether there is true congenital anatomical narrowing, or whether there is merely a functional hypertrophy of the pyloric sphincter muscle
  • In adults, the cause is a narrowed pylorus due to scarring from chronic peptic ulceration
Dx
  • Thickened pylorus is felt classically as an olive-shaped mass in the epigastric (middle upper), or RUQ of the infant's abdomen
Tx
  • ABC's, stabilizing with IV fluids, as the danger of pyloric stenosis comes from dehydration and electrolyte disturbance (acidemia, low chloride levels), which can be achieved in 1-2 days
  • Surgery, the typical Mx, as very few cases are mild enough to be treated medically
  • IV and oral atropine can be used to Tx pyloric stenosis, successful 87% of the time. However, it requires prolonged hospitalization. It can be an alternative to surgery in kids who have contraindications, or parents who don't want surgery
  • Pyloromyotomy (100% successful), via Ramstedt's procedure (i.e. dividing the pyloric muscle to open the gastric outlet), through a single incision or more commonly, laparoscopically
Epidemiology
  • Most often occurs in the first few weeks of life (2-6 weeks), when it is called infantile hypertrophic pyloric stenosis
  • More common in male babies
  • Pyloric stenosis also occurs in adults

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Definition of Pyloric stenosis | Autoprac


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