Aklan State University

School of Arts and Sciences

Bachelor of Science in Nursing
Banga, Aklan

In Partial Fulfillment of the Requirements in Related Learning Experience II

Readings:
Pyloric Stenosis

Submitted by:
Bontia, Lourenz S.
BSN II

Submitted to:
Ma Ehn G. Milloroso, RN

March 3, 2016

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 Pyloric Stenosis

Definition:

Pyloric stenosis, also called infantile

hypertrophic pyloric stenosis, is a condition caused by
an enlarged pylorus. The pylorus is a muscle that
opens and closes to allow food to pass through the
stomach into the intestine. When this muscle
becomes enlarged, feedings are blocked from
emptying out of the stomach. The retained feedings
cause the infant to vomit.i

Risk Factors:ii

Key risk factors: Adopted from:

http://pedsurg.ucsf.edu/media/85927
Male sex (M:F = 4:1) /img_main.gif

Caucasian ethnicity
Family history: there is a 20-fold increase in risk if sibling affected and an increased risk
in children of an affected parent (5-20% of sons, 2.5-7% of daughters).

Potential risk factors:

Maternal smoking
Postnatal exposure to macrolide antibiotics and prostaglandins
Formula feeds
Trans-pyloric feeding tubes
Prone sleeping position.

Cause:

There is no known reason for enlargement of the pylorus.

Pyloric stenosis is one of the most common conditions requiring surgery in infants. It is
more common in boys than girls and usually affects children who are born at full term. It rarely

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occurs in premature infants. Although not thought to be hereditary, pyloric stenosis occurs more
commonly in children of parents who had pyloric stenosis themselves as infants.i

Signs and Symptoms:

The main symptom of pyloric stenosis is vomiting undigested breast milk or formula soon
after a feeding. Vomiting usually begins at four weeks of age but can happen as early as two
weeks after birth. Once vomiting begins it becomes more frequent, and severe, and is often
described as "forceful" or "projectile". Infants with pyloric stenosis may become fussy and, since
they cannot keep down all their feedings, are hungry between feedings and are not able to gain
weight normally. If the vomiting continues infants may become ill from dehydration. i

Pathophysiology:

Frequent vomiting results in loss of H+, Cl-, Na+ and K+(electrolyte concentrations in gastric
fluid are 130-150 mmol/L for Cl-, 60-100 mmol/L for Na+, and 10-15 mmol/L for K+). As more acid
is secreted into the stomach, gastric cells release HCO3- into plasma. Alkalosis is further
exacerbated by the limited ability of the kidney to excrete HCO3- and because the HCO3-
preferentially accompanies Na+ uptake in the proximal convoluted tubule when there is a deficit
of Cl- (gastric Cl- losses exceed those of Na+). In pyloric stenosis, hypokalaemia is primarily due
to renal rather than gastric losses. With decreased filtration of Cl-, the activity of the Na+ / Cl-
symporter in the distal tubule is reduced and Na+ uptake becomes dependent on the cation
exchanger, which takes up Na+ in exchange for K+ or H+. With alkalosis, K+ is preferentially
exchanged for Na+. However, when total body K+ is depleted, H+ is also lost in the distal tubule
resulting in paradoxical acidification of urine.ii

Diagnosis:

An examination of the abdomen may allow the doctor to feel the enlarged pyloric muscle
(called an "olive"). If the pylorus cannot be felt, pyloric stenosis can be diagnosed by ultrasound
study or by x-rays taken after the infant drinks a liquid called "contrast." This is a study which
examines the stomach and small intestine and is called an upper GI. i

Treatment:

Pyloric stenosis does not get better by itself and must be corrected with an operation. The
operation is called a "pyloromyotomy" where the surgeon cuts through the muscle fibers of
enlarged pyloric muscle in order to widen the opening into the intestine. Prior to the operation,
your child will be admitted to the hospital for intravenous fluids. Feedings will be held temporarily

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and restarted after the operation. A blood sample will be taken to check for dehydration and
electrolyte abnormalities. Electrolytes measure the amount of sodium, potassium, carbon dioxide
and chloride in the blood. The surgeon will schedule the operation as soon as the infant's
electrolyte levels are normal and the dehydration is corrected. This may take a day of treatment
with intravenous fluids. A pyloromyotomy can be done using a small telescope and two miniature
instruments through several small bandaid sized incisions, or it can be done through a very small
incision on the abdomen. The operation usually takes about an hour. i

Nursing Considerations (Pre and Post-Operative): ii

Consider thermoregulation at all times

o Before transport to theatre, transfer infant to incubator set at neutral thermal
environment (NTE) temperature
o Ensure incubator will be plugged in and pre-warmed for the infant to be
transferred into in recovery
o After return to the ward, ensure infant's temperature is stable prior to transferring
to open cot
o Monitor infant's temperature hourly until stable
Routine post anaesthetic observations
Monitor wound and report abnormalities to surgeon
o Observe for bleeding, redness, swelling, ooze from incision site
o Refer wound care guideline
Maintain adequate fluid balance chart
Monitor IV site
Ensure adequate pain relief; use pain assessment tool

i
Harrison, M. (2015). Pyloric Stenosis. Retrieved February 29, 2016, from Pediatric Surgery:
http://pedsurg.ucsf.edu/conditions--procedures/pyloric-stenosis.aspx

ii
Pyloric Stenosis Management in NICU (Butterfly Ward). (2013). Retrieved February 29, 2016, from The Royal
Children's Hospital Melbourne:
http://www.rch.org.au/neonatal_rch/clinical_practice_guidelines/Pyloric_Stenosis_Management_in_NICU/

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 Reaction Paper:

Pyloric stenosis is a rare condition that has unknown origin. Not because pyloric stenosis
is rare we are just going to shrug it off. Pyloric stenosis is a serious condition that has lots of
complications.
Pyloric stenosis for me is racist, because males are more commonly affected than
females, with firstborn males affected about four times as often and it is more common in
Caucasians than Hispanics, Blacks, or Asians. What a racist condition! Although it is a racist
condition, it can affect almost every person on earth its just so happen that white men are more
affected.
Pyloric stenosis has unknown cause but mothers who are smoking are more likely to have
a baby with this condition. Smoking is really a horrible thing, not that it brought PROM, miscarriage
and other threats to the health of the fetus but also pyloric stenosis.
Pyloric stenosis is curable. It is curable by a surgery called pyloromyotomy. Although it
is curable, not all patient has the chance to be cured. Pyloromyotomy is expensive.
If for example there is a patient who has a pyloric stenosis, and lets just say that he resides
here in the Philippines, I dont think he will be cured firstly because it is Philippines, Philippines
has no adequate equipment, secondly that patient has no money and lastly people are not aware
of this condition.
I must say that we, Asians, are very lucky that this condition is racist, that it is most likely
to affect white men.