Pyloric stenosis, with its full name 'Infantile Hypertrophic Pyloric Stenosis', is the most important cause of gastric outlet obstruction and non-bilious vomiting in the first two months of life in infants. The 'pylorus', which consists of muscle mass and located between the stomach outlet and the first part of the small intestine, the pylorus, opens and closes at regular intervals, adjusting the passage of food from the stomach to the small intestine in portions. Excessive growth (hypertrophy) in this muscle tissue prevents the opening of the pylorus and the food in the stomach cannot pass into the small intestine. At this time, babies vomit in a gush style immediately after feeding and cannot meet their nutritional needs. This causes the child to become dehydrated and lose vital minerals.
What are the causes?
How exactly does pyloric stenosis develop? It is not known for certain what causes this condition. However, genetic, environmental factors and some disorders in the cells of the pyloric tissue (neural cell dysfunction, receptor deficiency, etc.) are thought to cause pyloric stenosis.
Although the genetically-causing disorder has not been fully revealed, it is 3-4 times more common in boys than girls, and one of the parents or one of the siblings has pyloric stenosis in infancy, which increases the risk of this disease in the newborn baby. In addition, conditions such as preterm birth, feeding with formula instead of breast milk, exposure to certain drugs may increase the risk of pyloric stenosis.
What symptoms does it give?
Babies with pyloric stenosis feed and gain weight like other healthy babies at birth. They vomit in small amounts like other healthy babies. However, between the 2nd and 8th weeks, especially in the 3rd to 5th weeks, after each feeding, increasingly more gushing vomiting begins to be seen. Vomiting is non-bilious and children want to be fed again after vomiting.
Children lose weight because they are not fed well, their stomachs are sunken, and their skin is dry due to water loss. Children who lose a lot of fluids and minerals are sluggish and sluggish. Although reflux disease is considered as the cause of vomiting, lying position and diet do not help and vomiting continues. m do
How is the diagnosis made?
The diagnosis is usually based on history and physical examination. Often their stories are similar. On physical examination, the enlarged pylorus in the abdomen, corresponding to the pylorus, appears as 'olive-olive'. USG is used as an auxiliary imaging method to confirm the diagnosis. Pyloric wall thickness greater than 4mm (3.5mm in premature infants) and longer than 16mm in USG confirms the diagnosis of pyloric stenosis.
At the same time, blood gas and electrolytes in the blood are checked. Mineral loss caused by vomiting is replaced. The patient is prepared for surgery.
Pyloric shorthand can also be confused with some surgical and non-surgical diseases. Although surgically, webs in the gastric outlet and duodenum, pyloric atresia, duplication cysts cause similar symptoms, they are much less common and can be diagnosed with additional examinations. Non-surgical diseases such as reflux disease, gastritis, pathologies that cause increased intracranial pressure, metabolic disorders may also cause vomiting in a similar way. For this reason, detailed history and examination are important.
What is the treatment?
Pyloric stenosis The treatment is surgically opening the thickened pyloric muscle layer and providing passage through the stomach (Ramstedt pyloromyotomy). The surgery can be performed openly or closed (laparoscopically) through a small incision of 2-3 cm. However, the superiority of the laparoscopic method over the open method in the treatment of pyloric stenosis has not been demonstrated.
Post-operative period
Post-operative On the same day, babies start to feed less – less and the amount is gradually increased. Generally, full feeding is started within 2-3 days and the baby is discharged. In some cases, vomiting may continue for a while after the surgery and it will return to normal over time.
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