Pyloric stenosis natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the [[duodenum]]. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature. The vomited material does not contain [[bile]] because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the stomach. | The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the [[duodenum]]. As a consequence, all ingested [[food]] and gastric secretions can only exit via [[Nausea and vomiting|vomiting]], which can be of a projectile nature. The vomited material does not contain [[bile]] because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the [[stomach]]. | ||
This results in loss of gastric acid ([[hydrochloric acid]]). The [[chloride]] loss results in [[hypochloremia]] which impairs the kidney's ability to excrete bicarbonate. This is the significant factor that prevents correction of the [[alkalosis]].<ref name="Acidbase">Kerry Brandis, [http://www.anaesthesiamcq.com/AcidBaseBook/ab7_3.php Acid-Base Physiology]. Retrieved December 31, 2006.</ref> | This results in loss of gastric acid ([[hydrochloric acid]]). The [[chloride]] loss results in [[hypochloremia]] which impairs the [[kidney]]'s ability to excrete [[bicarbonate]]. This is the significant factor that prevents correction of the [[alkalosis]].<ref name="Acidbase">Kerry Brandis, [http://www.anaesthesiamcq.com/AcidBaseBook/ab7_3.php Acid-Base Physiology]. Retrieved December 31, 2006.</ref> | ||
A secondary [[hyperaldosteronism]] develops due to the [[hypovolaemia]]. The high [[aldosterone]] levels causes the [[Kidney|kidneys]] to: | A secondary [[hyperaldosteronism]] develops due to the [[hypovolaemia]]. The high [[aldosterone]] levels causes the [[Kidney|kidneys]] to: | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the duodenum. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature. The vomited material does not contain bile because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the stomach.
Vomiting after surgery is the most common complication of infantile hypertrophic pyloric stenosis. Failure to gain weight in the newborn ,Bleeding and Infection after surgery are the other complications of infantile pyloric stenosis.
Natural History
The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the duodenum. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature. The vomited material does not contain bile because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the stomach.
This results in loss of gastric acid (hydrochloric acid). The chloride loss results in hypochloremia which impairs the kidney's ability to excrete bicarbonate. This is the significant factor that prevents correction of the alkalosis.[1]
A secondary hyperaldosteronism develops due to the hypovolaemia. The high aldosterone levels causes the kidneys to:
- Avidly retain Na+ (to correct the intravascular volume depletion)
- Excrete increased amounts of K+ into the urine (resulting in hypokalaemia).
The body's compensatory response to the metabolic alkalosis is hypoventilation resulting in an elevated arterial pCO2.
Associated Conditions
About 7% of babies will have other conditions such as intestinal malrotation, urinary tract obstruction, and esophageal atresia.
Complications
- Vomiting after surgery -- this is very common and generally improves with time
- Failure to gain weight in the newborn period
- Risks associated with any surgery, which include:
Prognosis
- Surgery usually provides complete relief of symptoms. The infant can usually tolerate small, frequent feedings several hours after surgery.
- As many as 80% of patients continue to regurgitate after surgery
- Patients who continue to vomit 5 days after surgery may warrant further radiologic investigation
References
- ↑ Kerry Brandis, Acid-Base Physiology. Retrieved December 31, 2006.