Pylorospasm

Gastroenterology

Clinicals - History

Fact Explanation
Vomiting Patients presents with projectile non-bilious vomiting. Patients feel hungry immediately after vomiting but they vomit soon after meals. This is common after heavy meals. Vomiting
Patients presents with projectile non-bilious vomiting. Patients feel hungry immediately after vomiting but they vomit soon after meals. This is common after heavy meals.
Failure to thrive Children with pylorospasm can present with failure to thrive due to recurrent vomiting. The child is always hungry and cries for feeds. Failure to thrive
Children with pylorospasm can present with failure to thrive due to recurrent vomiting. The child is always hungry and cries for feeds.
Symptoms of peptic ulcer disease Patients with pylorospasm are susceptible to develop peptic ulcer disease due to prolonged gastric emptying time. Retention of food and acid in the stomach is the causative factor.
Patients with peptic ulcer disease presents with burning epigastric pain, which is relieved with food and exacerbated by fasting.
Symptoms of peptic ulcer disease
Patients with pylorospasm are susceptible to develop peptic ulcer disease due to prolonged gastric emptying time. Retention of food and acid in the stomach is the causative factor.
Patients with peptic ulcer disease presents with burning epigastric pain, which is relieved with food and exacerbated by fasting.
Symptoms of dehydration Increased thirst, reduced urine output, dry skin, altered consciousness are symptoms of dehydration secondary to excessive vomiting. Symptoms of dehydration
Increased thirst, reduced urine output, dry skin, altered consciousness are symptoms of dehydration secondary to excessive vomiting.

Clinicals - Examination

Fact Explanation
Loss of weight Patients with pylorospasm can have loss of weight. Infants often have failure to thrive due to recurrent vomiting. Loss of weight
Patients with pylorospasm can have loss of weight. Infants often have failure to thrive due to recurrent vomiting.
Irrtabilty Infants with pylorospasm are irritable and crying due to hunger. Irrtabilty
Infants with pylorospasm are irritable and crying due to hunger.
Signs of dehydration Reduced skin turgor, dry mucous membranes, sunken eyes, tachycardia and small volume pulse are signs of dehydration. In severe dehydration patient may have reduced blood pressure, postural hypotension or even shock. Sunken fontanelle can be seen in infants. Signs of dehydration
Reduced skin turgor, dry mucous membranes, sunken eyes, tachycardia and small volume pulse are signs of dehydration. In severe dehydration patient may have reduced blood pressure, postural hypotension or even shock. Sunken fontanelle can be seen in infants.

Investigations - Diagnosis

Fact Explanation
Ultrasound scan Ultrasound scan is a non-invasive investigation used in making the diagnosis. Presence of double-track sign (false impression of two lumen due to hypertrophied and irregular esophageal musculature), subsequent scans showing changes in pyloric wall thickness, length and diameter and passage of gastric contents in to the duodenum are suggestive of pylorospasm. Ultrasound scan
Ultrasound scan is a non-invasive investigation used in making the diagnosis. Presence of double-track sign (false impression of two lumen due to hypertrophied and irregular esophageal musculature), subsequent scans showing changes in pyloric wall thickness, length and diameter and passage of gastric contents in to the duodenum are suggestive of pylorospasm.
Barium meal In pylorospasm ingested Barium will slowly empty in to the duodenum and most of the contrast is seen to be retained in the stomach. Barium meal
In pylorospasm ingested Barium will slowly empty in to the duodenum and most of the contrast is seen to be retained in the stomach.

Investigations - Management

Fact Explanation
Renal function test Dehydration can lead to acute renal failure. Altered electrolyte balance and raised creatinine can be observed. Renal function test
Dehydration can lead to acute renal failure. Altered electrolyte balance and raised creatinine can be observed.

Management - Supportive

Fact Explanation
Health education Parents should be advised to avoid over feeding the child. Frequent small meals will reduce the incidence of vomiting and help to gain weight. Health education
Parents should be advised to avoid over feeding the child. Frequent small meals will reduce the incidence of vomiting and help to gain weight.
Rehydration Intravenous fluids should be administrated as oral fluids can precipitate vomiting. Rehydration
Intravenous fluids should be administrated as oral fluids can precipitate vomiting.

Management - Specific

Fact Explanation
Conservative management Some patients can be managed conservatively. Patients are advised to avoid large meals as this can precipitate pylorospasm. Conservative management
Some patients can be managed conservatively. Patients are advised to avoid large meals as this can precipitate pylorospasm.
Antispasmodics Antispasmodics can be used in the treatment of pylorospasm. Calcium channel blockers, sildenafil and nitrates are commonly used. Antispasmodics
Antispasmodics can be used in the treatment of pylorospasm. Calcium channel blockers, sildenafil and nitrates are commonly used.
Surgery For the treatment of refractory pylorospasm, Rammstedt division of the pylorus is indicated. Vagotomy is also proven to reduce pylorospasm. Surgery
For the treatment of refractory pylorospasm, Rammstedt division of the pylorus is indicated. Vagotomy is also proven to reduce pylorospasm.

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