Pyloric Stenosis
A malformation in the lower part of the stomach (pylorus) through which food enters the small intestine, one of the more common causes of intestinal obstruction during infancy that requires surgery. About one in every 250 babies is affected. An infant with pyloric stenosis has a thickened, stiffened, enlarged pylorus, which prevents food from emptying out of the stomach.
Risk Factors
Pyloric stenosis affects about four times as many firstborn male infants as females. There is a hereditary component; if a parent had pyloric stenosis, an infant has up to a 20 percent risk of developing the same condition. Pyloric stenosis also occurs more commonly in Caucasian infants and in those babies with blood type B or O, usually between two weeks and two months of age.
Cause
Experts suspect that the problem is not congenital, but that infants develop a progressive thickening of the pylorus after birth until it becomes so thick that the stomach can no longer empty properly. Although experts are not sure what triggers the muscle thickening, some researchers suspect that maternal hormones or allergies could be a contributing cause. Others believe that some babies lack receptors in the pyloric muscle that detect nitric oxide, a chemical that induces the pylorus muscle to relax, so that the muscle contracts almost continually, causing it to thicken over time.
Symptoms
Symptoms of pyloric stenosis generally appear around three weeks of age and include projectile vomiting, stool changes, lethargy, failure to gain weight, losing weight, and a rippling belly.
Vomiting This is usually the first symptom of pyloric stenosis, beginning with simple spitting up that turns into projectile vomiting at the end of a feeding, although in some cases it may be delayed for hours. Rarely, the vomit may contain blood. Sometimes the vomited milk may smell curdled because it has mixed with stomach acid. A baby with pyloric stenosis is usually hungry again soon after vomiting.
Stool changes Babies with pyloric stenosis usually have fewer, smaller stools because not much food is entering the intestines. The baby may be constipated or produce greasy stools.
Failure to thrive Because these babies are not getting nourished properly, many babies with pyloric stenosis will stop gaining weight or even begin to lose weight. As their condition worsens, they are at risk for becoming dehydrated. An infant who is dehydrated is listless and will exhibit a sunken soft spot on their heads, sunken eyes, and softened or wrinkled skin on the belly and upper parts of the arms and legs. There may be four to six hours between wet diapers.
Belly ripples After feeding, babies with pyloric stenosis may exhibit stomach contractions that make noticeable ripples over the infant’s belly from left to right as the stomach tries to empty itself against the thickened pylorus.
Diagnosis
Detailed descriptions of a baby’s feeding and vomiting patterns plus a description of the vomit can help diagnose pyloric stenosis. During a physical exam, the doctor will try to feel if there is a movable lump about the size of an olive in the infant’s belly. If no lump is felt, an ultrasound of the infant’s belly will usually be ordered, which can reveal an enlarged, thickened pylorus.
Treatment
Pyloric stenosis is a medical emergency that requires immediate surgical treatment with a pyloromyotomy, in which the thickened muscles of the pylorus are cut, relieving the obstruction. The surgery is performed with general anesthesia and lasts about an hour.
Any dehydration or electrolyte problems in the blood will be corrected with intravenous fluids. After surgery, most babies are able to eat normally very soon, usually feeding again three to four hours after surgery. However, because of swelling at the surgery site, the baby may still vomit a bit for a day or so after surgery. As long as there are no complications, most babies who have undergone pyloromyotomy can return to a normal feeding schedule and be sent home within 48 hours of the surgery. The condition does not usually recur after a complete pyloromyotomy.
Risk Factors
Pyloric stenosis affects about four times as many firstborn male infants as females. There is a hereditary component; if a parent had pyloric stenosis, an infant has up to a 20 percent risk of developing the same condition. Pyloric stenosis also occurs more commonly in Caucasian infants and in those babies with blood type B or O, usually between two weeks and two months of age.
Cause
Experts suspect that the problem is not congenital, but that infants develop a progressive thickening of the pylorus after birth until it becomes so thick that the stomach can no longer empty properly. Although experts are not sure what triggers the muscle thickening, some researchers suspect that maternal hormones or allergies could be a contributing cause. Others believe that some babies lack receptors in the pyloric muscle that detect nitric oxide, a chemical that induces the pylorus muscle to relax, so that the muscle contracts almost continually, causing it to thicken over time.
Symptoms
Symptoms of pyloric stenosis generally appear around three weeks of age and include projectile vomiting, stool changes, lethargy, failure to gain weight, losing weight, and a rippling belly.
Vomiting This is usually the first symptom of pyloric stenosis, beginning with simple spitting up that turns into projectile vomiting at the end of a feeding, although in some cases it may be delayed for hours. Rarely, the vomit may contain blood. Sometimes the vomited milk may smell curdled because it has mixed with stomach acid. A baby with pyloric stenosis is usually hungry again soon after vomiting.
Stool changes Babies with pyloric stenosis usually have fewer, smaller stools because not much food is entering the intestines. The baby may be constipated or produce greasy stools.
Failure to thrive Because these babies are not getting nourished properly, many babies with pyloric stenosis will stop gaining weight or even begin to lose weight. As their condition worsens, they are at risk for becoming dehydrated. An infant who is dehydrated is listless and will exhibit a sunken soft spot on their heads, sunken eyes, and softened or wrinkled skin on the belly and upper parts of the arms and legs. There may be four to six hours between wet diapers.
Belly ripples After feeding, babies with pyloric stenosis may exhibit stomach contractions that make noticeable ripples over the infant’s belly from left to right as the stomach tries to empty itself against the thickened pylorus.
Diagnosis
Detailed descriptions of a baby’s feeding and vomiting patterns plus a description of the vomit can help diagnose pyloric stenosis. During a physical exam, the doctor will try to feel if there is a movable lump about the size of an olive in the infant’s belly. If no lump is felt, an ultrasound of the infant’s belly will usually be ordered, which can reveal an enlarged, thickened pylorus.
Treatment
Pyloric stenosis is a medical emergency that requires immediate surgical treatment with a pyloromyotomy, in which the thickened muscles of the pylorus are cut, relieving the obstruction. The surgery is performed with general anesthesia and lasts about an hour.
Any dehydration or electrolyte problems in the blood will be corrected with intravenous fluids. After surgery, most babies are able to eat normally very soon, usually feeding again three to four hours after surgery. However, because of swelling at the surgery site, the baby may still vomit a bit for a day or so after surgery. As long as there are no complications, most babies who have undergone pyloromyotomy can return to a normal feeding schedule and be sent home within 48 hours of the surgery. The condition does not usually recur after a complete pyloromyotomy.
Tags: failure to gain weight, lethargy, losing weight, malformation in the lower part of the stomach, prevents food from emptying out, projectile vomiting, Pyloric Stenosis, pylorus, rippling belly, stool changes
Posted in Health and Wellness
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