Professional Documents
Culture Documents
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Nitrous oxide synthase deficiency (most accepted ) Nerve cell theory ( ganglion cell theory)
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3/1000 live birth Definite familial incidence Male:Female = 4:1 Commonly in the first born male child Most common cause for laparotomy before 1 year Age: 3 weeks - 3 months
Gastric dilataion
Stagnation gastritis
1. Vomiting
Non-bilious Progressive Projectile or forcible Persistent Immediately after meals Child is hungry and eager to eat after Sometimes, coffee ground due to gastrits
Test feeding revealed visible peristalsis from the left to the right in the upper abdomen.
Olive shaped mass pyloric tumor at the angle between right rectus muscle and the liver.
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Serum electrolytes ( sodium, potassium, chloride) diminished Urea elevated Blood glucose diminished
3. Arterial blood gases (ABG)
Metabolic alkalosis
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Dilated stomach with single bubble sign Scanty gases distal to the obstruction
Dilated stomach Delayed gastric emptying Hypertrophic gastric rugae String sign: Narrow & elongated pyloric canal Beak sign: Narrow pyloric lumen/channel to a point Shoulder sign: impression on the antrum and the duodenal cap by the thick muscle Double track sign: when the narrow pyloric channel is lined on opposing luminal surface with contrast
Diagnosis is confirmed when: Pyloric muscle thickness (serosamucosa) 4mm Pyloric thickness (serosaserosa) 15mm Pyloric channel length 17mm Circumferential muscular thickening surrounding the central channel and filled with mucosa( target sign.
Pyloric atresia Antral web Pylorospasm Gastro-oesophageal reflux Gastric volvolus Preampular duodenal stenosis Ectopic pancreas within the pyloric muscle
Medical
Hospitalization NG suction Correction of fluid,electrolytes & pH disturbances Maintenance fluid with 5% dextrose in 0.45% normal saline containing 20-40 mEq/l KCl.
Fred-Ramstedts pyloromyotomy
Right upper quadrant transverse or umbilical fold incision Delivery of the hypertrophied pylorus Splitting of the pyloric muscle till mucosal bulge
Fred-Ramstedts pyloromyotomy
Fred-Ramstedts pyloromyotomy
Crystalloid resuscitation is continued postoperatively until the patient returns to full feeding.
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Pyloric stenosis
Age
Sex
3weeks 3 months
Male predominance
Clinical
Investigation
Treatment
Surgical
A 3-week-old, first-born male develops forceful, nonbilious emesis. Which of these findings establishes the diagnosis? (A) ultrasonographic pyloric muscle thickness of 2.5 mm (B) ultrasonographic pyloric thickness greater than 1.5 cm (C) ultrasonographic pyloric diameter of 1.0 cm or less (D) an UGI series showing a classic "double bubble" sign (E) palpable pyloric mass (olive) midline of the abdomen
A 4-week-old breast-fed boy was completely well untill 2 days earlier, when he began vomiting all feeds. He was otherwise well, and keen to feed the persistent vomiting.
(a) (b) (c) (d)
What is the significant thing to ask about regarding vomiting? What physical sign would you wish to find to confirm the diagnosis you suspect? If you were unable to demonstrate this sign, what would you do if you still suspect? What initial investigations would you perform to assist you in resuscitation?