Vomiting, Regurgitation and Dysphagia Hypertrophic Pyloric Stenosis |
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Incidence | |
Frequent cause of vomiting in early infancy. Maximum occurrence from the end of the first month to the beginning of the second month of life; mainly in boys. | |
Clinical significance | |
1. If ignored hypertrophic pyloric stenosis may lead to a dangerous exsiccosis or a failure to thrive. | |
Etiology | |
Unknown. | |
Pathology, anatomical types | Illustrations |
Hypertrophy of the pyloric muscle of the stomach which becomes clinically manifest to a different degree and during the first three months at a different time. | show details |
Pathophysiology | Illustrations |
A progressing exsiccosis, a hypochloremic (hypopotassemic) metabolic alcalosis and failure to thrive develops following recurrent vomiting. A possible hypoventilation is a trial to compensate the alcalosis. | show details |
Clinical presentation (history, findings, clinical skills) | Illustrations |
History and findings: Vomiting shortly after ingestion, which develops very fast or gradually to the typical clinical picture: Projectile vomiting during every feeding or shortly thereafter. Frowning due to spasms of the stomach. Development of signs of exsiccosis as standing wrinkles, of diarrhea (so-called starvation stools) and arrest of increase of weight and loss of weight as sign of failure to thrive. Clinical skills: | show details |
Natural history | Illustration |
Possible are | show details |
Differential diagnosis | Illustrations |
The differential diagnosis includes all causes of vomiting, regurgitation and dysphagia because the three symptoms cannot be well differentiated from each other in infancy. In case of clinical manifestation in the newborn the differential diagnosis of an obstructive ileus has to be considered, and in case of coffee-ground appearance due to a gastritis or esophagitis the other causes leading to hematemesis as for instance gastroesophageal reflux. The latter is in case of vomiting one of the main differential diagnoses of hypertrophic pyloric stenosis. | show details |
Work-up examinations | Illustrations |
1. Serumanalysis for fluid and electrolyte abnormalities. Clinical assessment of the degree of exsiccation (weight prior and at the beginning of the disease and at hospitalization and signs of exsiccosis). | show details |
Therapy | Illustrations |
Prior pyloromyotomy the electrolyte and fluid imbalance should be corrected because the postoperative course is then uneventful and the operation is not emergent. | show details |
Prognosis | |
Total recovery including a secondary gastroesophageal reflux. In case of persistent vomiting an incomplete pyloromyotomy, a combination with a primary reflux or a rare cause has to be considered.
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