Hypertrophic Pyloric Stenosis: Risk factor, Clinical features, Diagnosis, Treatment: Surgery

📌 𝐅𝐨𝐥𝐥𝐨𝐰 𝐨𝐧 𝐈𝐧𝐬𝐭𝐚𝐠𝐫𝐚𝐦:-   / drgbhanuprakash   📌𝗝𝗼𝗶𝗻 𝗢𝘂𝗿 𝗧𝗲𝗹𝗲𝗴𝗿𝗮𝗺 𝗖𝗵𝗮𝗻𝗻𝗲𝗹 𝗛𝗲𝗿𝗲:- https://t.me/bhanuprakashdr 📌𝗦𝘂𝗯𝘀𝗰𝗿𝗶𝗯𝗲 𝗧𝗼 𝗠𝘆 𝗠𝗮𝗶𝗹𝗶𝗻𝗴 𝗟𝗶𝘀𝘁:- https://linktr.ee/DrGBhanuprakash Hypertrophic Pyloric Stenosis: Risk factor, Clinical features, Diagnosis, Treatment: Surgery - ----------------------------------------------------------------------------------------------------------------- Hypertrophic Pyloric Stenosis (HPS) is a condition that affects infants, typically between the ages of 2 to 8 weeks. It involves the thickening of the pyloric muscle at the junction of the stomach and duodenum, leading to obstruction of gastric outflow. This condition is a common cause of projectile vomiting in infants and often requires surgical correction. The exact cause is unknown, but genetic and environmental factors may play a role. Pathogenesis - In HPS, the pylorus (the muscular valve that regulates the passage of food from the stomach to the small intestine) becomes hypertrophied. This thickening leads to: Narrowing of the pyloric canal, preventing food from moving out of the stomach. Increased gastric peristalsis as the stomach tries to force contents through the narrow pylorus. Progressive vomiting, leading to dehydration and weight loss. The condition is more common in first-born male infants and tends to run in families, suggesting a genetic predisposition. Clinical Features - 1. Projectile Vomiting: Non-bilious vomiting (no bile because the obstruction is proximal to the bile duct) that is often forceful, described as projectile. Usually occurs after feeding and worsens over time. 2. Palpable Olive-Shaped Mass: On physical examination, an olive-shaped mass can often be palpated in the right upper quadrant of the abdomen. This is the hypertrophied pylorus. 3. Dehydration: Signs of dehydration, such as sunken fontanelles, dry mucous membranes, and reduced urine output, are common due to frequent vomiting. 4. Weight Loss or Poor Weight Gain: The infant may fail to gain weight or may lose weight despite an apparently good appetite. 5. Visible Peristalsis: Peristaltic waves may be seen moving from left to right across the abdomen as the stomach attempts to force food past the obstruction. Lab Findings - Laboratory tests in patients with HPS often show signs of dehydration and electrolyte imbalance due to persistent vomiting: Hypokalemic, Hypochloremic Metabolic Alkalosis: Vomiting leads to a loss of stomach acid, resulting in alkalosis (elevated blood pH). Low potassium and chloride levels are typically noted. Increased Bicarbonate: In compensation for the metabolic alkalosis, the kidneys retain bicarbonate, leading to elevated levels. Signs of Dehydration:Elevated hematocrit and blood urea nitrogen (BUN) due to dehydration. Imaging : 1. Ultrasound (the gold standard): Ultrasound typically shows an elongated and thickened pylorus. Pyloric muscle thickness is greater than 3mm and a pyloric canal length greater than 17mm are diagnostic criteria for HPS. "Target sign" and "Double-track sign" are classic ultrasound findings. 2. Upper Gastrointestinal Series: Used if the ultrasound is inconclusive. It shows the string sign or railroad track sign, which represents a thin stream of barium passing through the narrowed pyloric canal. Management The treatment of hypertrophic pyloric stenosis is primarily surgical. Preoperative Management: Correction of Dehydration: Before surgery, it's crucial to stabilize the infant by correcting dehydration and electrolyte imbalances with IV fluids. Typically, normal saline with added potassium is used. Gastric Decompression: Nasogastric tube insertion may be used to decompress the stomach and prevent further vomiting. Surgical Management: The definitive treatment for HPS is pyloromyotomy, also known as Ramstedt’s procedure:In this procedure, the surgeon makes an incision in the muscle of the pylorus without cutting through the mucosa, relieving the obstruction. Laparoscopic pyloromyotomy is becoming increasingly popular due to smaller incisions and quicker recovery times. Postoperative Care: Feeding can usually begin within 12-24 hours after surgery, starting with small amounts of clear liquids and gradually increasing to formula or breast milk. The prognosis is excellent, with most infants recovering fully without long-term complications. #HypertrophicPyloricStenosis #InfantHealth #PediatricSurgery #ProjectileVomiting #Pyloromyotomy #NeonatalCare #PediatricGastroenterology #SurgeryAwareness #PyloricStenosisTreatment #InfantCare #medicalanimations #fmge #fmgevideos #rapidrevisionfmge #fmge2024 #mbbslectures #nationalexitexam #nationalexittest #neetpg #usmlepreparation #usmlestep1 #fmge #usmle #drgbhanuprakash #medicalstudents #medicalstudent #medicalcollege #neetpg2025 #usmleprep #usmlevideos #usmlestep1videos #medicalstudents #neetpgvideos #usmlestep2videos