LET’S DEFINE

Pylorus- The part of the stomach that connects to the

duodenum (first part of the small intestine). It is a valve
that opens and closes during digestion.
Pyloric Sphincter- a ring of smooth muscle that
regulates release of gastric contents into the
duodenum.
Stenosis- it means “narrowing”
The stomach is an organ in the upper abdomen. It can
Duodenum- it is first part of the small intestine.
be divided into fundus, body, antrum and pylorus.
Hyperplasia- the increase (in mass) of an organ or Pylorus connects the stomach to the duodenum (the 1
tissue. st section of the small intestine). It is a valve that opens
and closes during digestion. Together, the pylorus and
Hypertrophy- is an increase in the size of cells or tissues. duodenum play an important role in helping to move
Pyloromyotomy- an incision in the wall of the pylorus. the food through the digestive system.

Laparoscopy- is a type of surgical procedure that allows

a surgeon to access the inside of the abdomen and
pelvis without having large incision in the skin.
PYLORIC STENOSIS
-A condition wherein the muscles of the pylorus are
abnormally thickened, which prevents the stomach
from emptying into the small intestine, and food backs
up into the esophagus.

➢This type of blockage is also referred to as a gastric

\
outlet obstruction. Wherein hypertrophy and
hyperplasia occurs in the muscles surrounding the PATHOPHYSIOLOGY
sphincter. Resulting in elongation and narrowing of
pyloric channel

➢ Muscles in the pyloric sphincter may thickened to as

twice its size, with a consistency similar to a cartilage.

➢ This condition usually develops in the first few weeks

of life (4-6 weeks).

➢ The exact cause is unknown but multifactorial

inheritance is most likely the cause of this condition.

➢ Pyloric stenosis occurs in 1 in 500-1000 live births,

affecting 4 males for every 1 female

➢ Usually occurs in first born white (Caucasian) male

infants, seen less frequently in African-American and
Asian infants.

➢ Occurs less frequently in breastfed infants than

formulafed infants.
The cause of pyloric stenosis is unknown, but factors MANIFESTATION
that might play a role are as follows:
❑ Projectile vomiting
✓ Hyperplasia
❑ Persistent-Chronic hunger
✓ Hypertrophy
❑ Decreased urine output
✓ Environmental factors
❑ Constipation
✓ Genetic Factors
❑ Signs of Dehydration and Malnutrition
Assessment and Diagnostic Findings
❑ Weight Loss
• Laboratory studies. Electrolytes, pH, BUN, and
creatinine levels should be obtained at the same time as ❑ Epigastric distension
intravenous access in patients with pyloric stenosis.
❑ Palpable olive-shaped tumor in the epigastrium
• Ultrasonography. If the clinical presentation is typical
and an olive is felt, the diagnosis is almost certain; ❑ Visible gastric peristaltic waves
however formal ultrasonography is still recommended NURSING Assessment in a child with pyloric stenosis
to evaluate the pylorus and confirm the diagnosis. include:
• Radiography. Radiographic studies with barium ➢ Assess the child’s history of vomiting. Ask when the
swallow show an abnormal retention of barium in the vomiting started and determine the character of the
stomach and increased peristalsis. vomiting.
Risk factors for pyloric stenosis include: ➢ Assess for the child’s elimination
✓ Sex of the baby: Full-term, first-born male babies are ➢ Physical exam
at higher risk. It’s less likely in baby girls.
NURSING INTERVENTION
✓ Race: It happens more to white infants, especially of
European descent. • Maintain adequate nutrition and fluid intake

✓ Family history of pyloric stenosis: About 15% of • Provide mouth care

infants with pyloric stenosis have a family history of it.
• Physical exam
The parent who had the condition before also matters.
An infant’s risk is three times higher if the mother had • Promote skin integrity
pyloric stenosis, compared to the father.
• Promote family coping
✓ Smoking: Babies whose mothers smoked during
Medical Treatment
pregnancy are at higher risk.
✓ Surgery called pyloromyotomy treats pyloric stenosis
✓ Antibiotics: Some babies who needed antibiotics
shortly after birth may be at higher risk. Babies whose ✓ Surgery can be performed laparoscopically or through
mothers took certain antibiotics late in pregnancy may a supra-umbilical incision
also have a higher risk. ✓ There’s no way to prevent pyloric stenosis. If you
✓ Approach to feeding: Some studies of babies drinking know pyloric stenosis runs in your family, make sure to
formula show an increased risk for pyloric stenosis. But tell your healthcare provider.
it remains unclear if the risk comes from the bottle or
the formula.
Medical Management (PRE-OPERATIVE) CONCLUSION
• Fluid Regimen and Electrolyte Correction - The baby ✓ Pyloric stenosis is a problem that causes forceful
will not have any surgery until the blood biochemistry is vomiting in babies from birth to 6 months of age. It can
normalized. lead to dehydration. In pyloric stenosis, the muscles in
the stomach that connect to the small intestine thicken.
• Proper Care of Infant
This causes the opening of the pylorus to become
- Monitor vital signs narrow.

- Referral process ✓ Pyloric stenosis is surgically managed, with a

Ramstedt’s pyloromyotomy7 and should not be
- Comfort measures-semi-fowlers or R side lying undertaken until any fluid or electrolyte abnormalities
- Education have been correction. Surgery can be performed
laparoscopically or through a supra-umbilical incision
Postoperative Care
• Monitor IV Fluid
• Provide feeding as prescribed by surgeon
• Document INO
• Monitor surgical site
NURSING DIAGNOSIS
Based on the assessment data, the major nursing
diagnoses are:
• Imbalanced nutrition: less than body requirements
related to inability to retain food.
• Deficient fluid volume related to frequent vomiting.
• Impaired oral mucous membrane related to NPO
status.
• Risk for impaired skin integrity related to fluid and
nutritional deficit.
• Compromised family coping related to seriousness of
illness and impending surgery.
EVALUATION
Goals are met as evidenced by:
• Improved nutrition and hydration
• Maintained mouth and skin integrity
• Relieved family anxiety