Pyloric stenosis
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Pyloric stenosis
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Pyloric stenosis
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Hypertrophic pyloric stenosis p. 368
Macrolides p. 190
hypertrophic pyloric stenosis and p. 368
Metabolic alkalosis p. 610, 616
in hypertrophic pyloric stenosis p. 368
Neonates
hypertrophic pyloric stenosis in p. 368
Pyloric stenosis p. 368
Vomiting
pyloric stenosis p. 368
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Transcript
Content Reviewers
Rishi Desai, MD, MPHContributors
Tanner Marshall, MS
With hypertrophic pyloric stenosis, hypertrophy refers to an increase in size, pyloric refers to the pylorus which is the tissue between the stomach and the duodenum, and stenosis means narrowing, so hypertrophic pyloric stenosis, or HPS, is a congenital condition where a baby’s pylorus grows in size such that it narrows the tiny opening between the stomach and the duodenum.
The pylorus itself has two parts to it, the pyloric antrum, which connects to the body of the stomach, and the pyloric canal, which connects to the duodenum.
At the end of the pyloric canal you’ve got the pyloric sphincter, which is a ring of smooth muscle that contracts and acts like a valve, letting food pass down into the duodenum, but not go back up into the stomach.
In HPS, babies are born with a normal pylorus, but within a few weeks after birth, the smooth muscle of the pyloric antrum begins to undergo hypertrophy and hyperplasia, meaning an increase in the size of each cell as well as an increase in the overall number of cells, respectively.
This causes the pyloric antrum to nearly double in size.
This thick and muscular antrum obstructs the pathway of food, which makes it harder for food to leave the stomach and enter the small intestine.
Clinically the enlarged pylorus can be felt as an “olive” in the right upper quadrant or epigastric region of the abdomen, which is just above the umbilicus.
Also, there’s normally contraction and relaxation of the smooth muscle lining the stomach, a process called peristalsis.
Obstruction from HPS can cause the stomach smooth muscle to have to work much harder to push food through, and sometimes there can even be hypertrophy of those muscles, which can result in peristalsis that can be felt or seen.
If food can’t pass through the pylorus, it quickly starts to build up to the point where it has nowhere to go, which can lead to vomiting.
This usually happens around 2-6 weeks, and can get more intense over time, until it ultimately starts causing projectile vomiting, called that because the vomit literally launches out of a child’s mouth.
Summary
Pyloric stenosis is the narrowing of the opening from the stomach to the duodenum, often caused due to hypertrophy of the muscle surrounding this opening, which spasms when the stomach empties. Pyloric stenosis causes severe projectile nonbilious vomiting after meals, abdominal pain, poor weight gain, and dehydration. It usually presents in the first few months of life, and the thickened pylorus can be felt classically as an olive-shaped mass in the middle upper part or right upper quadrant of the infant's abdomen. Pyloric stenosis can be treated with pyloromyotomy, a surgical procedure that enlarges the pylorus.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Pyloric stenosis of infancy and primary hyperacidity - the missing link" Acta Paediatrica (2014)
- "Diagnosis and Therapy of Primary Hypertrophic Pyloric Stenosis in Adults: Case Report and Review of Literature" Journal of Gastrointestinal Surgery (2006)
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