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Partial Pyloric Obstruction


Presentation

  • More than 70 acute pediatric presentations are covered in a signs and symptoms section designed with side tabs for easy access.[books.google.com]
  • In severe cases, a scaphoid abdomen and protruding ribcage may be present. 1,2 Atypical Presentations Premature infants with IHPS and those with certain medical or surgical conditions may present atypically.[mdedge.com]
  • Nausea is usually present but may occur without any vomiting. Pain in the upper middle abdominal area (epigastric region) which may not always be present depending on the cause of the obstruction.[healthhype.com]
Cyanotic Congenital Heart Disease
  • الصفحة 285 - High-risk category Prosthetic cardiac valves, including bioprosthetic and homograft valves Previous bacterial endocarditis Complex cyanotic congenital heart disease (eg, single ventricle states, transposition of the great arteries, tetralogy[books.google.com]
  • Prostaglandin E2 administration in infants with ductus-dependent cyanotic congenital heart disease . Eur J Pediatr 1987 ;146: 279 –82. 3. Lewis AB, Freed MD, Heymann MA, Roehl SL, Kensey RC. .[nejm.org]
Atrial Septal Defect
  • الصفحة 285 - ... leaflets" Endocarditis prophylaxis not recommended Negligible-risk category (no greater risk than the general population) Isolated secundum atrial septal defect Surgical repair of atrial septal defect, ventricular septal defect, or patent[books.google.com]
  • The patient (female, age 17 years) presented with growth retardation, microcephaly, facial dysmorphia, oesophageal atresia, aortic stenosis, ventricular septal defect, atrial septal defect II, hypothyroidism, and learning disability, but no pyloric stenosis[cambridge.org]
Streptococcal Infection
  • الصفحة 286 - Clinical findings Arthralgia Fever Laboratory findings Elevated acute phase reactants Erythrocyte sedimentation rate C-reactive protein Prolonged PR interval Supporting Evidence of Antecedent Group A Streptococcal Infection Positive throat[books.google.com]
Vomiting
  • They include: Vomiting. The first symptom is usually vomiting.[kidshealth.org]
  • Being sick (vomiting) after a feed is the main symptom. The vomiting often starts like a 'normal' vomit and milk just dribbles down the front of the baby. Sometimes the vomiting is forceful and milk may be vomited quite a distance like a fountain.[patient.info]
  • A 7-week-old white boy presented to the emergency department (ED) with vomiting and weight loss. His parents brought him to the ED 3 weeks earlier after he had vomited for several days.[consultant360.com]
  • IHPS rarely causes bilious vomiting and most frequently occurs in infants between ages 3 and 6 weeks.[mdedge.com]
Nausea
  • In addition the patient also complains of frequent pain in the upper part of the abdomen, early satiety, nausea, loss of appetite and weight loss. At times, non-projectile vomiting and jaundice may occur.[medindia.net]
  • Typical symptoms and signs are abdominal distention, pain, constipation, nausea, and vomiting, with partial obstructions leading to less severe symptoms. Severe cases are often accompanied by dehydration and electrolyte abnormalities.[amboss.com]
  • Background Gastric outlet obstruction (GOO) presents with nausea and vomiting and usually develops over weeks to months [ 1 ]. It may be complete or incomplete with intermittent symptoms.[bmcgastroenterol.biomedcentral.com]
  • It may be preceded by indigestion and nausea as the stomach attempts to squeeze its contents through an ever narrowing outlet. Hypertrophic pyloric stenosis appears soon after birth.[medical-dictionary.thefreedictionary.com]
  • If you experience any of the following symptoms for more than two weeks, it is advised that you see a gastroenterologist: Unexplained weight loss Severe abdominal pain Nausea and vomiting Loss of appetite Vomiting blood Tarry stool Difficulty or painful[hopkinsmedicine.org]
Regurgitation
  • Isolated secundum atrial septal defect Surgical repair of atrial septal defect, ventricular septal defect, or patent ductus arteriosus (without residual effects beyond 6 mo) Previous coronary artery bypass graft surgery Mitral valve prolapse without valvar regurgitation[books.google.com]
  • . • Aspiration of gastric contents should be done to ensure a clearer view and to prevent regurgitation of contents into the air-passages. • Patient’s diet should be restricted to liquids only, in those with severe stenosis. • Patients are given pharyngeal[slideshare.net]
Mitral Valve Prolapse
Palpitations
  • This edition's highlights include new chapters on palpitations, cystic fibrosis, travel related emergencies, and ultrasound and a new appendix on practice pathways.[books.google.com]
Arthralgia
  • الصفحة 286 - Clinical findings Arthralgia Fever Laboratory findings Elevated acute phase reactants Erythrocyte sedimentation rate C-reactive protein Prolonged PR interval Supporting Evidence of Antecedent Group A Streptococcal Infection Positive throat[books.google.com]
Cesarean Section
  • الصفحة 284 - Vaginal delivery" Cesarean section In uninfected tissue Urethral catheterization Uterine dilatation and curettage Therapeutic abortion Sterilization procedures Insertion or removal of intrauterine devices Other... ‏[books.google.com]
Neglect
  • Identify and manage the psychosocial issues surrounding pediatric patients, including major depression and suicidality, sexual and physical abuse, child neglect, and violence.[books.google.com]

Workup

  • Surgical Bowel obstruction requires a swift workup to establish whether emergent surgery is necessary! References: [1][amboss.com]
  • As part of the initial workup, exclude the possibility of functional nonmechanical causes of obstruction, such as diabetic gastroparesis.[emedicine.medscape.com]
  • WORKUP Laboratory Studies • Obtain a CBC. Check the hemoglobin and hematocrit to. rule out the possibility of anemia. • Obtain an electrolyte panel.[slideshare.net]
Positive Throat Culture
  • الصفحة 286 - Clinical findings Arthralgia Fever Laboratory findings Elevated acute phase reactants Erythrocyte sedimentation rate C-reactive protein Prolonged PR interval Supporting Evidence of Antecedent Group A Streptococcal Infection Positive throat[books.google.com]
Prolonged PR Interval
  • الصفحة 286 - Clinical findings Arthralgia Fever Laboratory findings Elevated acute phase reactants Erythrocyte sedimentation rate C-reactive protein Prolonged PR interval Supporting Evidence of Antecedent Group A Streptococcal Infection Positive throat[books.google.com]

Treatment

  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.com]
  • Causation related to ulcers may involve severe pain which the patient may interpret as a heart condition/attack. [1] Treatment of the condition depends upon the underlying cause; it can involve antibiotic treatment when Helicobacter pylori is related[en.wikipedia.org]
  • Learn more about treatment for gastric cancer at Johns Hopkins. Basics Stomach Cancer: How to Find the Best Treatment Team Gastric Cancer: Answers from Expert Fabian Johnston What to Know About Stomach Cancer Surgery Gastric Cancer Stephanie’s Story[hopkinsmedicine.org]
  • Two aspects need to be addressed in treatment: Anti-tubercular medications Relief from obstruction. Anti-tuberculous treatment should be given according to standard WHO guideline. There is no specific guideline for prolonging ATT beyond 6 months.[jdeonline.in]

Prognosis

  • Described sonographic signs include: antral nipple sign cervix sign target sign Treatment and prognosis Initial medical management is essential with rehydration and correction of electrolyte imbalances.[radiopaedia.org]
  • Prognosis A functioning and unrestricted intestine is a prerequisite for living independent of the most advanced and continuous medical care available. Achieving this desirable goal is the rule with surgery for duodenal obstructions of all types.[medical-dictionary.thefreedictionary.com]
  • . • In patients with largely metastatic disease, determine the degree of surgical intervention for palliation in light of the patient's realistic prognosis and personal wishes. 22.[slideshare.net]
  • The prognosis following surgery is excellent. A REMINDER . . . The diagnosis of pyloric stenosis is frequently delayed. Consider pyloric stenosis as a cause of emesis in infants.[consultant360.com]
  • Google Scholar Jaffin BW, Kaye MD: The prognosis of gastric outlet obstruction. Ann Surg. 1985, 201: 176-179.[bmcgastroenterol.biomedcentral.com]

Etiology

  • Nine children (age 3 mo to 17 years) presented with a history of late-onset primary GOO of unknown etiology[ 9 ].[wjgnet.com]
  • Pathology Etiology Gastric outlet obstruction can be due to malignant or benign causes.[radiopaedia.org]
  • Typically, treated infants recover quickly and can begin feeding within hours after surgery. 3,8 Although the etiology of IHPS remains unknown, providers can quickly recognize the signs and symptoms of IHPS in order for surgical treatment to be scheduled[mdedge.com]
  • The incidence of GOO in patients with peripancreatic malignancy, the most common malignant etiology, has been reported between 15- 20%.[tropicalgastro.com]
  • To date, none of the theories proposed offers a definitive answer to the question of the etiology of HPS.[basicmedicalkey.com]

Epidemiology

  • KEY WORDS epidemiology infantile hypertrophic pyloric stenosis SIDS Abbreviations: ICD-10 — International Classification of Diseases, 10th Revision IHPS — infantile hypertrophic pyloric stenosis IQR — interquartile range IRR — incidence relative ratios[pediatrics.aappublications.org]
  • Schechter R, Torfs CP, Bateson TF (1997) The epidemiology of infantile hypertrophic pyloric stenosis. Paediatr Perinat Epidemiol 11: 407–427. View Article Google Scholar 8.[journals.plos.org]
  • Epidemiology. 2006 Mar;17(2):195-201. PMID: 16477261. RCH Melbourne CPG. Pyloric stenosis. Sola JE, Neville HL. Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis. J Pediatr Surg. 2009 Aug;44(8):1631-7.[lifeinthefastlane.com]
  • Epidemiology The incidence of GOO has been reported to be less than 5% in patients with PUD, which is the leading benign cause of the problem.[emedicine.medscape.com]
  • Epidemiology 2006; 17 : 195–201. 2. Carter CO : The inheritance of congenital pyloric stenosis. Br Med Bull 1961; 17 : 251–254. 3. Mitchell LE, Risch N : The genetics of infantile hypertrophic pyloric stenosis. A reanalysis.[nature.com]
Sex distribution
Age distribution

Pathophysiology

  • It provides complete, authoritative information on the biology of the newborn and the pathophysiology and management of diseases during the neonatal period.[books.google.com]
  • Pathophysiology Intrinsic or extrinsic obstruction of the pyloric channel or duodenum is the usual pathophysiology of GOO; the mechanism of obstruction depends upon the underlying etiology.[emedicine.medscape.com]
  • Malignant Tumours of the stomach, including adenocarcinoma (and its linitis plastica variant), lymphoma, and gastrointestinal stromal tumours Pathophysiology [ edit ] In a peptic ulcer it is believed to be a result of edema and scarring of the ulcer,[en.wikipedia.org]
  • Pathophysiology Intrinsic or extrinsic obstruction of the pyloric channel or duodenum is the usual pathophysiology of GOO; as previously noted, the mechanism of obstruction depends upon the underlying etiology.[laparoscopyhospital.com]
  • Is the venous gas consistent with the pathophysiology of the suspected diagnosis? Answer and interpretation Yes The pylorus is normal at birth. There is progressive hypertrophy of the pyloric muscle resulting in gastric outlet obstruction.[lifeinthefastlane.com]

Prevention

  • Prevention of bacterial endocarditis. Recommendations by the American Heart Association. ‏[books.google.com]
  • In order to prevent closure of the gastrostomy, a Foley catheter was immediately put in place. Several hours later the patient presented with vomiting.[revistagastroenterologiamexico.org]
  • Oversew the area with a continuous suture to prevent a postoperative leak. No drainage procedure is required. E. Complications 1.[laparoscopyhospital.com]
  • Prevention Prompt and effective treatment of peptic ulcers will prevent chronic scarring and narrowing. Drugs developed over the past few decades have all but eliminated the need for ulcer surgery.[medical-dictionary.thefreedictionary.com]
  • SALINAS, MD, is an assistant professor in the Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center.[aafp.org]

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