Nursing NotesMy Student Support SystemPYLORIC STENOSIS
Pyloric stenosis is a
narrowing of the opening from the stomach to the first part of the small
intestine (the pylorus) Symptoms include projectile
vomiting without the presence of bile. It may be congenital anomaly or some times may be
developed later and is characterized by hypertrophy of circular muscles of
pylorus.
Sign and Symptoms -
·
Vomiting after feeding- The baby
may vomit , ejecting breast milk or formula up to several feet away (projectile
vomiting). Vomiting might be mild at first and gradually become more severe as
the pylorus opening narrows. The vomit may sometimes contain blood, but no
bile.
·
Persistent hunger- Babies who have pyloric
stenosis often want to eat soon after vomiting because there is no absorption
of nutrients as food is not reaching to small intestine.
·
Stomach contractions- You may
notice wave-like contractions (peristalsis) that goes across your baby's upper
abdomen soon after feeding but before vomiting as stomach muscles trying to
force food through the narrowed pylorus.
·
Dehydration- The baby become dehydrated
as milk is not reaching to small intestine for absorption. The baby might cry
without tears or become lethargic.
·
Changes in bowel movements- Since
pyloric stenosis prevents food from reaching the intestines, babies with this
condition might be constipated.
·
Weight problems- Pyloric stenosis leads to
weight loss, as no absorption of nutrition is taking place. The child becomes
malnourished.
·
Palpable mass- Pyloric stenosis may present
with palpable mass in the upper right quadrant of the abdomen.
Diagnostic Investigations-
Ø History- of projectile vomiting after each feed
Ø Palpation- palpable pyloric mass
Ø X-ray -Barium meal X-ray Examination
Ø Blood
Invstigations- serum electrolytes and ABG
Treatment -
Surgery is needed
to treat pyloric stenosis. The procedure (pyloromyotomy) is often scheduled on
the same day as the diagnosis. If your baby is dehydrated or has an electrolyte
imbalance, he or she will have fluid replacement before surgery.
In pyloromyotomy,
the surgeon cuts only through the outside layer of the thickened pylorus
muscle, allowing the inner lining to bulge out. This opens a channel for food
to pass through to the small intestine.
Nursing Management -
- Preoperatively vital signs should be monitored and
recorded
- Dehydration and
electrolyte imbalance is treated as per doctor order IV fluid infusion may be
needed
- The small feeds
are given slowly and the child is burped frequently
-The Infant
should be kept in upright position for on right side with head and slightly
elevated
- Parents
are explained about the disorder,
treatment procedure and all questions are
answered to alleviate anxiety.
- Sometimes
nasogastric tube is in place so NG tube care suction should be done frequently.
- After surgery
proper observation and vital signs monitoring should be done
- Watch out for
abdominal distension and should be reported immediately
- IV Fluids
should be maintained as per doctors order
-Test feed is
offered after 6 hours after surgery if tolerated then breastfeed is given using
expressed breast milk.
- Parents are explained about follow up and care after discharge.
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