best approach to Congenital Hypertrophic Pyloric Stenosis 2024

Understanding Congenital Hypertrophic Pyloric Stenosis: Causes, Symptoms, and Treatments”



The most common surgical disease of the stomach in infants is hypertrophic pyloric stenosis.
Due to the pylorus’s circular muscle fibres’ growth, it has grown longer, thicker, and narrower.
Boys are more likely to have it. It occurs more frequently in infants with blood types B and O.

•TEF and hypoplasia or agenesis of the inferior labial frenulum are related congenital abnormalities that may be linked to Turner syndrome and Trisomy 18.

At birth, symptoms are not evident. Vomiting typically begins after three weeks of age.

Clinical signs and symptoms


Pyloric stenosis typically isn’t present at birth.

Pyloric stenosis’s earliest symptoms are nonbilious vomiting. Vomiting often begins about three weeks of age, while symptoms can appear as early as the first week of life and as late as five months.
Emesis may occur intermittently or after each eating. The child is hungry after puking and wants to be fed.-
Vomiting causes a gradual loss of fluid, hydrogen ions, and chlorides. Hypochloremic metabolic alkalosis is the effect of this. Although serum potassium levels are typically kept stable, the body may be deficient in potassium overall.

In the beginning, the kidneys are able to compensate by reabsorbing hydrogen and chloride ions in place of sodium, potassium, and bicarbonate; however, as the body’s stores of sodium and potassium become depleted, these ions are selectively retained while hydrogen is excreted in urine, leading to the paradoxical aciduria. The alkalosis is made worse by this

Diagnosis of congenital hypertrophic pyloric stenosis


History of vomiting without bile (nonbilious vomiting).
Physical examination –
i) Palpable mass in the epigastrium
ii) After feeding, visible gastric peristaltic wave that progresses across the abdomen.
USG confirm the diagnosis
Criteria → Pyloric thickness > 4 mm or an overall pyloric length > 14 mm.
Contrast studies –
i) Shoulder sign
→ A bulge of the pyloric muscle into the antrum.
ii) Double tract sign→ Parallel streaks of barium in the narrowed channel.
iii) Elongated pyloric channel.
Various signs in CHPS
Mushroom sign
Caterpillar sign
Diamond sign
Shoulder sign
Beak sign

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