Pyloric stenosis natural history, complications and prognosis: Difference between revisions

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Revision as of 18:59, 28 November 2017

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, Complications, and Prognosis

Natural History

The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
The symptoms of (disease name) typically develop ___ years after exposure to ___.
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

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:
- Bleeding
- Infection

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

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 ==Natural History, Complications, and Prognosis==
 ===Natural History===
+* The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
+* The symptoms of (disease name) typically develop ___ years after exposure to ___.
+* If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
-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>
-A secondary [[hyperaldosteronism]] develops due to the [[hypovolaemia]]. The high [[aldosterone]] levels causes the [[Kidney|kidneys]] to:
-*Avidly retain Na<sup>+</sup> (to correct the intravascular [[volume depletion]])
-*Excrete increased amounts of K<sup>+</sup> into the [[urine]] (resulting in [[hypokalaemia]]).
-The body's compensatory response to the [[metabolic alkalosis]] is [[hypoventilation]] resulting in an elevated arterial p[[Carbon dioxide|CO<sub>2</sub>]].
 ===Associated Conditions===
 About 7% of babies will have other conditions such as [[intestinal malrotation]], [[urinary tract obstruction]], and [[esophageal atresia]].