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Hypertrophic Pyloric Stenosis [HPS] Interventions
Hiker-trophy with Pylorus-pie of Stone
The primary goal of caring for the newborn with HPS is to correct electrolyte and fluid balance prior to surgical treatment to relieve the obstruction. Following surgery, the newborn is able to resume a normal feeding schedule within a couple of days.
7 KEY FACTS
Pyloromyotomy is the standard of treatment and has excellent outcomes. It involves the surgeon cutting through the muscle fibers of the pyloris. This relieves the pyloric contraction, which was obstructing flow of gastric contents to the duodenum.
It is important to stabilize the hydration status and monitor intake and output of the newborn. Furthermore, the fluid and electrolyte imbalances should be corrected and you should administer fluids intravenously [as prescribed] for rehydration. This includes correcting metabolic alkalosis, which can develop from repeated vomiting.
Often, if the newborn has excessive vomiting, an NG tube will be placed to decompress the stomach and relieve its contents.
Preoperatively, you should monitor feeding and observe if vomiting occurs. Depending on how far out from surgery the newborn is, they may be prescribed to be NPO.
Postoperatively, you should begin small, frequent feedings as prescribed. Mothers may begin formula feedings or breastfeeding within 24 hours of pyloromyotomy.
Gradually, the amount and intervals of feeding should increase. It is recommended that feedings occur every 4-6 hours, and these feedings should include glucose, water, or electrolyte solution. The infant should be fed slowly, burped frequently and the infant should be handled minimally after feedings.
The parents should be educated that within 2 days, the infant should have full feeding. This diet should be maintained, and the infant should be monitored for abdominal distention.
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PYLORIC STENOSIS:
Review the anatomy and physiology of digestive system
Review the incidence of pyloric stenosis
Define pyloric stenosis
Explain the causes and risk factors of pyloric stenosis
Describe the pathophysiology of pyloric stenosis
Enumerate clinical features of pyloric stenosis
Enlist the diagnostic evaluation for pyloric stenosis
Explain the management of
pyloric stenosis
Enumerate the complications of pyloric stenosis
PYLORIC STENOSIS:
Review the
anatomy and physiology of digestive system
Review the incidence of pyloric stenosis
Define pyloric stenosis
Explain the causes and risk factors of pyloric stenosis
Describe the pathophysiology of pyloric stenosis
Enumerate clinical features of pyloric stenosis
Enlist the diagnostic evaluation for pyloric stenosis
Explain the management of pyloric stenosis
Enumerate the complications of pyloric stenosis
Once the diagnosis of congenital hypertrophy pyloric stenosis has been definitely established by a history of projectile vomiting with palpation of the pyloric tumor by an experienced clinician, or if no tumor is palpated but an upper gastrointestinal series demonstrates the typical string sign and an elongated pyloric canal with gastric retention of barium, the main consideration is the preparation of the infant for the Fredet-Ramstedt operation. All these patients demonstrate a varying degree of dehydration, weight loss, and metabolic alkalosis, which need correction prior to surgical intervention. Only when an adequate formula can be taken by mouth and absorbed will the infant be able to replace the protoplasm he has lost and begin to grow.
The aim of preoperative treatment is to restore as quickly, but as safely, as possible most of the accumulated electrolyte and water losses; to ensure sufficient hemoglobin and protein content of the blood; to