Over time inflammation and edema further reduce the size of the opening, resulting in complete obstruction. The hypertrophied pylorus may be palpable as an olivelike mass in the upper abdomen. Pyloric stenosis is not a congenital disorder. Diagnosis Hypertrophic Pyloric Stenosis H&P - olivelike mass is palpated easily when the stomach is empty, the infant is quiet, and the abdominal muscles are relaxed. o Vomiting usually occurs 30 to 60 minutes after feeding and becomes projectile as the obstruction progresses Ultrasonography- Ultrasound will demonstrate an elongated, sausage shaped mass with an elongated pyloric channel. Upper GI Radiography Metabolic Alterations from prolonged vomiting (hypochloremic, hypokalemic metabolic alkalosis) BOX 41-15 CLINICAL MANIFESTATIONS OF HYPERTROPHIC PYLORIC STENOSIS Projectile vomiting o May be ejected 3-4 feet from the child when in a side lying position, 1 foot or more when in a back lying position o Shortly after a feed 51
o May follow each feed or appear intermittently o Nonbilious vomiting, it may be blood tinged Infant hungry, avid nurser, eagerly accepts a second feeding after vomiting episode No evidence of pain or discomfort except that of chronic hunger Weight loss Signs of dehydration Distended upper abdomen Readily palpable olive shaped tumor is the epigastrium just to the right of the umbilicus Visible gastric peristaltic waves that move from left to right across the epigastrium Therapeutic Management Hypertrophic Pyloric Stenosis Pyloromyotomy ; Surgical intervention Before surgery infant must be rehydrated, metabolic alkalosis corrected with parenteral fluid and electrolytes (may delay up to 24 to 48 hrs) Stomach decompression with NG tube Post-OP - Feedings begin 4 to 6 hours postop with small, frequent feeds of glucose water or electrolyte solutions followed by formula or breast milk as tolerated High success rate Care Management Preoperative Care Hypertrophic Pyloric Stenosis NPO with IV fluids (Dextrose and Electrolyte replacement)-restore hydration VS Labs- electrolytes Skin and mucous membrane assessment Gastric tube is patent and functioning properly Postoperative Care Hypertrophic Pyloric Stenosis IV fluids till infant can handle by mouth VS I/O Analgesics for pain around the clock Surgical incision for drainage and inflammation (1297-1299)- the most common cause of intestinal obstruction in children between the ages of 3 months and 3 years Intussusception occurs when a proximal segment of the bowel invaginates into the distal segment, pulling the mesentery and compressing it • Lymphatic and venous congestion and bowel wall edema can cause obstruction of the intestine, and infarction and perforation of the bowel wall can occur • Venous engorgement also leads to leaking of blood and mucus into the intestinal lumen forming currant jelly stools • Most common site is the ileocecal valve Diagnosis of Intussusception Ultrasonography Spontaneous reduction in 10% of patients (which means it goes away on its own) Therapeutic Management of Intussusception
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