Pyloric Stenosis (HPS): Symptoms, Causes, Treatment

What are the symptoms of pyloric stenosis?

Pyloric stenosis is a condition in infants where the pylorus, the opening from the stomach to the small intestine, becomes narrowed, obstructing the passage of food. The symptoms typically present within the first few weeks of life and may include:

• Projectile Vomiting: This is a key symptom, where the infant vomits forcefully and the vomit often travels a considerable distance. It usually occurs shortly after feeding.
• Persistent Hunger: The baby may seem excessively hungry and may want to feed more frequently due to the inability to keep food down.
• Dehydration: Signs include dry mouth, reduced urine output, and fewer wet diapers. The infant may also have sunken eyes and a dry, wrinkled skin.
• Weight Loss: Due to persistent vomiting and poor food intake, the infant may not gain weight appropriately or may lose weight.
• Abdominal Distension: The abdomen may appear swollen or distended due to the buildup of gas and food that cannot pass through the narrowed pylorus.
• Olive-shaped Mass: In some cases, a firm, olive-shaped lump may be felt in the upper right side of the abdomen, which is the hypertrophied pylorus.
• Lethargy: The infant may become unusually sleepy or irritable due to dehydration and malnutrition.
• Electrolyte Imbalances: Symptoms of imbalances may include abnormal muscle tone, irregular heartbeat, or changes in skin color.

If pyloric stenosis is suspected, it’s important to seek medical evaluation promptly. Early diagnosis and treatment are crucial to prevent complications and ensure proper growth and development.

What are the causes of pyloric stenosis?

The exact cause of pyloric stenosis is not fully understood, but several factors are thought to contribute to its development. These include:

• Genetic Factors: There may be a genetic predisposition, as pyloric stenosis can run in families. A family history of the condition increases the risk.
• Environmental Factors: Certain environmental factors or prenatal conditions may contribute, though specific triggers are not well defined.
• Gender: Pyloric stenosis is more common in males than females, suggesting that gender may play a role in its development.
• Age: The condition typically develops in infants between 2 and 8 weeks of age. It is less common in newborns or older children.
• Prenatal Factors: Some research suggests that factors such as maternal smoking or certain prenatal conditions might be associated with an increased risk of pyloric stenosis.
• Genetic Mutations: Research has identified certain genetic mutations that may be linked to pyloric stenosis, although these are not the sole cause and are part of a broader set of contributing factors.
• Other Medical Conditions: In some cases, pyloric stenosis may be associated with other conditions, such as metabolic disorders or congenital anomalies, although this is less common.

Overall, while there are known risk factors and associations, the precise cause of pyloric stenosis in most cases is not clearly defined. The condition arises from a combination of genetic and environmental factors that lead to the abnormal thickening of the pyloric muscle.

What is the treatment for pyloric stenosis?

The treatment for pyloric stenosis typically involves surgical intervention, as this is the most effective way to resolve the obstruction. Here’s a detailed overview of the treatment approach:

• Surgical Correction: The primary treatment for pyloric stenosis is a surgical procedure called pyloromyotomy. This surgery involves making an incision to split the thickened pyloric muscle, allowing it to open and enabling food to pass from the stomach into the small intestine. Pyloromyotomy is usually performed laparoscopically (using small incisions and a camera) or through an open surgical approach.
• Preoperative Care: Before surgery, the infant will need to be stabilized. This involves:
• Hydration and Electrolyte Replacement: Administering fluids and electrolytes to address dehydration and imbalances caused by persistent vomiting.
• Nutritional Support: Providing intravenous nutrition to ensure the infant receives adequate nutrients while they cannot eat normally.
• Postoperative Care: After surgery, the infant will be monitored for recovery, including:
• Feeding Progress: Gradual reintroduction of oral feedings, starting with clear liquids and then advancing to more substantial foods as tolerated.
• Pain Management: Medications to manage pain and ensure comfort.
• Monitoring for Complications: Watching for any signs of infection, surgical complications, or issues with feeding.
• Long-Term Follow-Up: Most infants recover well from the surgery and can return to normal feeding and growth. Follow-up appointments will be scheduled to monitor the infant’s progress and ensure that there are no residual issues.

Early diagnosis and timely treatment are crucial for a good outcome, and most infants do very well after surgery, with significant improvement in their symptoms and overall health.