A Family Doctor's Tale - PYLORIC STENOSIS

DOC I HAVE PYLORIC STENOSIS

Pyloric Stenosis is a stricture at the lower end of the stomach (pylorus)which can obstruct outflow of gastric content to the duodenum.

Two main causes of Pyloric Stenosis are :
1.Congenital
The pyloric stenosis occur in 0.2 per cent of live births with a preponderance ratio of 4 males to 1 female.
There is a familial history.

2.Acquired
a.Scarring - gastric juice burns into the protective lining of the stomach resulting in gastritis or peptic ulcer. The resultant scarring of the stomach lining at the pylorus may cause narrowing or stenosis of the outlet obstructing the outflow of gastric content. Scarring can occur in 5-10 per cent of peptic ulcers especially duodenal ulcers.

b.Spasm of the pyloric muscles due to gastritis or peptic ulcer can also reduce the opening at the outlet of the stomach.

c.mechanical obstruction from a tumor of the stomach

Early cases of pyloric stenosis can be reversed more easily.

Later cases results in gastris dilatation with retention of gastric contents due to obstruction.

Vomiting of the retained food in the stomach is a natural progression of the condition.

The most common symptoms and signs of Pyloric Stenosis are :
1.upper abdominal upset or pain.

2.belching, abdominal bloating, aversion to food

3.nausea, and vomiting of ingested food

4.Protracted copious vomiting due to obstruction at the outflow of the stomach

Signs:
5.gastric splash can be felt and heard on examination

6.weight loss

7.dehydration

Pyloric Stenosis is diagnosed through one or more medical tests:
1.Upper gastrointestinal endoscopy.
In the case of pyloric stenosis, the gastric content (usually large amount) has to be removed by aspiration through a stomach tube 3 hours before any procedure can be done.

The doctor eases an gastroscope, a thin tube containing a tiny camera, through your mouth  and down into your stomach to look at the stomach lining for polyps or tumors blocking the pylorus. If there is no tumor, there may evidence of gastritis or peptic ulcer and narrowing of the passage of the pylorus from scarring or spasm.

2.MRI of the upper abdomen usually shows the presence of excess stomach content and may show evidence of any benign tumor or cancer.

3.Blood tests for electrolytes in cases of dehydration

The main treatment of Pyloric Stenosis is usually
1.correction of fluid and electrolyte deficit by intravenous infusion of saline and glucose

2.removal of stomach content through a nasogastric tube to eliminate distension of stomach and restore tone of stomach muscles

Medications:
Treatment usually involves taking drugs
1.Antacids:to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.)
2.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)
3. Antispasmodics: anticholinergic drugs like buscopan.librax reduce the spasm in the stomach and duodenum
4.If the peptic ulceris caused by an infection, that problem may be treated with antibiotics to clear up H. pylori infection.

Surgery:
Surgical treatment may be necessary to remove any tumor or cancerous groth causing blockage.

Any stricture in the pylorus may be dilated or removed for the food to empty out easily to the duodenum.

The Complications of untreated Pyloric Stenosis are

1.dehydration

2.anorexia and loss of weight

3.perforated stomach and peritonitis

Prognosis of Pyloric Stenosis is :
good to excellent if treated early except for cases of cancer of the stomach.

Prevention of Pyloric Stenosis:
avoid gastritis and peptic ulcers