Lightning Learning: Pyloric Stenosis
Thickened pyloric muscle obstructing the passage of milk going into the bowel. Vomiting can often be mistaken as reflux initially.
Incidence: 2-4 infants per 1000 at around 4-6 weeks of age. More common in boys than girls 4:1 (ratio), particularly first born. Familial. Cause is unknown.
Only 1-in-7 will have the common triad of projectile vomiting, visible peristalsis and the palpable “olive”.
Dehydrated baby with projectile nonbilious vomiting. Wants feeds and is hungry, but vomits causing weight loss.
Blood gas: hypochloraemic/hypokalaemia metabolic alkalosis (see infographic).
NGT pre-op – NBM. Replace gastric losses as per local policy. Refer to Paediatric Surgeon who may consider USS to confirm diagnosis.
Treatment? Surgical pyloromyotomy.
Always consider in the vomiting infant.