Pyloric Stenosis
Definition
Pyloric stenosis is a condition where the pylorus, the passage between the stomach and small intestine, narrows, causing gastric outlet obstruction.
Types
- Congenital Pyloric Stenosis: This is the most common type, usually seen in infants and young children.
- Acquired Pyloric Stenosis: This type can occur at any age due to various causes such as trauma, inflammation, or malignancy.
Pathophysiology
- Hypertrophy: Proliferation of smooth muscle cells in the pylorus wall, leading to narrowing of the pyloric channel.
- Obstruction: The narrowed pyloric channel blocks the normal passage of food from the stomach to the small intestine, causing gastric outlet obstruction.
Clinical Features
- Projectile Vomiting: Forceful vomiting of food, which may be bilious in infants.
- Dehydration: Vomiting leads to loss of fluids and electrolytes.
- Weight Loss: In severe cases, weight loss may occur due to inadequate nutrient absorption.
- Abdominal Mass: A palpable mass may be felt in the right upper quadrant of the abdomen.
Complications
- Metabolic Alkalosis: Loss of hydrogen ions and chloride ions in vomited gastric contents can lead to metabolic alkalosis.
- Malnutrition: Prolonged gastric outlet obstruction can cause malabsorption of nutrients.
Investigations
- Ultrasound: The most common diagnostic tool, which shows thickening of the pyloric muscle and narrowing of the pyloric channel.
- Barium Study: X-ray examination with barium sulfate swallowed, which shows narrowing of the pyloric channel.
- Lab Tests: Blood tests may show metabolic alkalosis and electrolyte imbalance.
Correlation of Clinical and Imaging Findings
Clinical features such as projectile vomiting and dehydration, along with imaging findings like thickening of the pyloric muscle and narrowing of the pyloric channel on ultrasound, confirm the diagnosis.
Surgical Management
- Ramstedt's Procedure: A simple surgical procedure where the muscle fibers are incised, allowing the pyloric channel to return to its normal diameter.
- Step 1 → Incision of the pyloric muscle
- Step 2 → Incision of the mucosa and submucosa
- Step 3 → Closure of the incision
Homeopathic Therapeutic Medicines
- Arsenicum album: For symptoms like vomiting, diarrhea, and abdominal pain.
- Ipecacuanha: For symptoms like nausea, vomiting, and diarrhea.
- Lycopodium: For symptoms like bloating, gas, and abdominal discomfort.