The pyloric stenosis is a thickening of the passage from the stomach to the duodenum. It prevents the passage of the chyme and leads to violent vomiting. Pyloric stenosis needs to be treated, otherwise it can cause a life-threatening condition.
What is pyloric stenosis?
The pylorus narrowing (medical: pylorus stenosis) is a thickening at the stomach outlet. The pylorus (pylorus) is a muscle that can close and open like a ring by contracting and relaxing due to circular fibers. See topbbacolleges for Definitions of Lymphadenopathy.
The pylorus separates the stomach from the duodenum. If the pylorus is thickened, it can no longer be opened wide enough to allow the chyme to pass into the intestine. As a result, the digested food remains in the stomach, where it begins to ferment and putrefaction begins.
The pyloric narrowing often occurs in infants from the second to eighth week of life, with boys being affected more often than girls. Adults can also suffer from pyloric stenosis, mostly due to scarring after gastric or intestinal ulcers have healed.
Causes
The exact cause of pyloric narrowing is not known. The disease is believed to be genetic in infants because it tends to run in families.
This means that in a family in which one parent already had a pyloric stenosis, the offspring are often affected as well. If the pyloric narrowing occurs in adults, the cause is often scarring of the pylorus. These sometimes develop after ulcers in the stomach or duodenum.
If they have been close to the pylorus, scars may form on the pylorus during the healing period. They thicken the sphincter and the pyloric constriction occurs. Another possible cause of a pyloric narrowing is the development of a tissue overgrowth directly at the stomach outlet.
Symptoms, Ailments & Signs
A typical symptom of pyloric stenosis is sudden vomiting shortly after eating a meal. This can lead to repeated vomiting, which takes place at short intervals. The odor of the stomach contents is usually very acidic. If the stomach is already irritated, there may be traces of blood in the vomit.
Since the outlet of the stomach is often thickened in pyloric stenosis, it can be clearly felt through the abdominal wall. You can also occasionally see the stomach muscles contract, which can be observed as a wave-like movement of the abdomen. Since liquid is also excreted with the vomit in addition to food, the children quickly suffer from deficiency symptoms.
They lose weight and become extremely thirsty, which manifests itself in downright greedy drinking. However, since they do not retain the liquid, the typical signs of dehydration appear over time, such as dark circles under the eyes, dry mucous membranes and so-called standing skin folds.
The latter are folds of skin drawn with the fingers, which remain in place when released. There is also severe pain in the upper abdomen. Sometimes jaundice can also occur, which is accompanied by yellowing of the skin and the originally white sclera of the eyes. All symptoms lead to total exhaustion over time and require urgent medical attention.
Diagnosis & History
The typical symptom of pyloric stenosis in infants is a surge of vomiting about 30 minutes after eating. The odor of the vomit is strongly acidic and sometimes thin threads of blood are visible.
Occasionally one can see through the abdominal wall the undulating movements of the stomach trying to empty itself through muscular contractions. The children feel unwell and have stomach pains. Since vomiting disrupts the intake of food and liquids, the child loses weight and shows signs of dehydration (exsiccosis) as the disease progresses, such as dry mucous membranes, a sunken fontanelle (soft spot on the top of the head) and dark circles under the eyes.
Adults with a narrowing of the pylorus feel thirsty and suffer from a feeling of fullness, they have to belch and vomit like in children. The doctor makes the diagnosis based on the symptoms and the medical history. With the help of an ultrasound examination, he can see whether there is a pyloric narrowing, since the thickened sphincter muscle is visible in the ultrasound.
A blood test is used to clarify whether the lack of liquid has already caused a lack of vital electrolytes and minerals.
Complications
In the worst case, the pyloric stenosis can lead to the death of the person concerned. However, this usually only occurs if treatment is not initiated. Patients suffer from persistent vomiting due to the thickening. It is not uncommon for the person concerned to become depressed or irritable.
Pain in the abdomen and stomach area can also occur and significantly reduce the patient’s quality of life. Vomiting usually occurs after eating. Persistent vomiting inevitably leads to severe weight loss in those affected. Young children often cry because of the pain, so the parents and relatives of the child are usually stressed and irritable.
Increased thirst and a strong feeling of fullness can also occur due to pyloric stenosis. The weight loss also leads to various deficiency symptoms that have a very negative effect on the health of the patient. The disease is usually treated without complications by surgical intervention. The symptoms disappear completely and do not appear again. The life expectancy of the patient is not reduced either.
Treatment & Therapy
The pyloric narrowing is usually treated surgically. Conservative therapy, i.e. non-surgical treatment, can only be used for very slight narrowing. It consists of giving the patient food in very small portions and administering drugs that cause muscle relaxation.
This therapy is very time-consuming and usually does not bring the desired success. In most cases, surgery is done, but this is only possible after the patient has been stabilized with electrolytes and liquid nutrition. In a surgical procedure called a pyloromyotomy (myo= muscle, tomie= incision), the ring-shaped muscle of the pylorus is divided with an incision and stretched open.
This increases the diameter of the passage. The operation can be performed with an incision in the abdomen (laparotomy) or through an examination of the abdomen (laparoscopy). During laparotomy, the abdominal wall is opened to access the pylorus. During laparoscopy, only three small incisions are made in the abdomen, through which a camera and the surgical instruments are inserted up to the pylorus. After the operation of the pyloric narrowing, solid food can be eaten again after a few days.
Prevention
A pyloric narrowing cannot be prevented as it is either congenital or caused by scarring. It is important to consult a doctor immediately if you suspect a pyloric obstruction, as the disease can lead to a life-threatening condition if left untreated.
Aftercare
Follow-up treatments and any follow-up examinations depend on the treatment method used. In most cases, infants are affected who are treated surgically – for example in a laparoscopic procedure. Babies usually recover very quickly from the procedure, so that a gradual build-up of feedings can take place soon after the operation.
The symptoms observed before the operation disappear quickly and there is no risk of a recurrence, i.e. a repetition of the pyloric stenosis. There are therefore no explicit follow-up recommendations. If the typical symptoms reappear, they should be taken as an opportunity to have more detailed examinations carried out. In less severe cases where no surgical treatment is indicated, the presenting symptoms suggestive of pyloric stenosis should be closely monitored.
In the very rare cases in which surgical treatment is urgently indicated but is not possible due to other diseases, the only option left is a jejunal feeding tube. It flows directly into the small intestine, bypassing the pylorus. In these cases, follow-up extends to ongoing care as long as the treatment of the secondary disease that prevents the primary surgical intervention continues.
