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Pyloric stenosis

PYLORIC STENOSIS:
Review the anatomy and physiology of digestive system
Review the incidence of pyloric stenosis
Define pyloric stenosis
Explain the causes and risk factors of pyloric stenosis
Describe the pathophysiology of pyloric stenosis
Enumerate clinical features of pyloric stenosis
Enlist the diagnostic evaluation for pyloric stenosis
Explain the management of pyloric stenosis
Enumerate the complications of pyloric stenosis

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Pyloric stenosis

  1. 1. 5/10/2019PYLORIC STENOSIS1
  2. 2. PRESENTED BY: Ann Joseph M.Sc. Nursing 1 year PYLORIC STENOSIS 5/10/20192 PYLORIC STENOSIS
  3. 3. 5/10/2019PYLORIC STENOSIS3
  4. 4. OBJECTIVES 5/10/2019PYLORIC STENOSIS4  Review the anatomy and physiology of digestive system  Review the incidence of pyloric stenosis  Define pyloric stenosis  Explain the causes and risk factors of pyloric stenosis  Describe the pathophysiology of pyloric stenosis
  5. 5. OBJECTIVES CONT. 5/10/2019PYLORIC STENOSIS5  Enumerate clinical features of pyloric stenosis  Enlist the diagnostic evaluation for pyloric stenosis  Explain the management of pyloric stenosis  Enumerate the complications of pyloric stenosis
  6. 6. ANATOMY AND PHYSIOLOGY OF STOMACH 5/10/2019PYLORIC STENOSIS6
  7. 7. 5/10/2019PYLORIC STENOSIS7
  8. 8. •3 in 1000 live birth •Predominant in males (5:1) •Commonly seen in first born male child •More commonly in child than the adult. INCIDENCE 5/10/20198 PYLORIC STENOSIS
  9. 9. Pyloric stenosis is defined as narrowing of the outlet of the stomach so that food cannot pass easily from it into the duodenum, resulting in feeding problem and projectile vomiting. DEFINITION 5/10/20199 PYLORIC STENOSIS
  10. 10. RISK FACTORS AND ETIOLOGY OF PYLORIC STENOSIS 5/10/2019PYLORIC STENOSIS10
  11. 11. Due to etiological factors Marked hypertrophy and hyperplasia of the circular and longitudinal muscular layer of pylorus PATHOPHYSIOLOGY 5/10/201911 PYLORIC STENOSIS
  12. 12. 5/10/2019PYLORIC STENOSIS12
  13. 13. Pyloric canal becomes lengthened and thickened Narrowing of gastric antrum Impaired emptying of gastric content Projectile vomiting PATHOPHYSIOLOGY CONT. 5/10/201913 PYLORIC STENOSIS
  14. 14. CLINICAL MANIFESTATION 5/10/2019PYLORIC STENOSIS14
  15. 15. Projectile vomiting CLINICAL MANIFESTATION CONT. 5/10/201915 PYLORIC STENOSIS
  16. 16. Constipation CLINICAL MANIFESTATION CONT. 5/10/201916 PYLORIC STENOSIS
  17. 17. Weight loss CLINICAL MANIFESTATION CONT. 5/10/201917 PYLORIC STENOSIS
  18. 18. Jaundice CLINICAL MANIFESTATION CONT. 5/10/201918 PYLORIC STENOSIS
  19. 19. Persistent hunger CLINICAL MANIFESTATION CONT. 5/10/201919 PYLORIC STENOSIS
  20. 20. Dehydration CLINICAL MANIFESTATION CONT. 5/10/201920 PYLORIC STENOSIS
  21. 21. Epigastric distension CLINICAL MANIFESTATION CONT. 5/10/201921 PYLORIC STENOSIS
  22. 22. Decreased urine output CLINICAL MANIFESTATION CONT. 5/10/201922 PYLORIC STENOSIS
  23. 23. Palpable pyloric mass CLINICAL MANIFESTATION CONT. 5/10/201923 PYLORIC STENOSIS
  24. 24. Stomach contraction CLINICAL MANIFESTATION CONT. 5/10/201924 PYLORIC STENOSIS
  25. 25. DIAGNOSTIC EVALUATION 5/10/2019PYLORIC STENOSIS25
  26. 26. DIAGNOSTIC EVALUATION 5/10/2019PYLORIC STENOSIS26  History collection  Physical examination  Abdominal USG  Test for metabolic alkalosis(ABG)  Urine analysis  CBC
  27. 27. 5/10/2019PYLORIC STENOSIS27
  28. 28. X RAY OF ABDOMEN CATERPILLAR SIGN 5/10/2019PYLORIC STENOSIS28
  29. 29. MANAGEMENT 5/10/2019PYLORIC STENOSIS29
  30. 30. •Symptomatic management •Managing dehydration and electrolyte imbalance Pharmacological management •Intravenous and oral atropine MEDICAL MANAGEMENT 5/10/201930 PYLORIC STENOSIS
  31. 31. SURGICAL MANAGEMENT 5/10/201931 PYLORIC STENOSIS
  32. 32. Ramstedt’s pyloromyotomy 5/10/2019PYLORIC STENOSIS32
  33. 33. Laproscopic pyloromyotomy 5/10/2019PYLORIC STENOSIS33
  34. 34. NURSING MANAGEMENT 5/10/2019PYLORIC STENOSIS34
  35. 35. Consider thermoregulation Before transferring to OT, transfer infant to incubator Ensure incubator is pre warmed for infant to be transferred into the recovery NURSING MANAGEMENT 5/10/201935 PYLORIC STENOSIS
  36. 36. NURSING MANAGEMENT CONT. 5/10/2019PYLORIC STENOSIS36 Monitor vitals hourly Monitor wound and report any abnormality Observe for bleeding, swelling, redness or ooze from incision site
  37. 37. Maintain adequate fluid balance Ensure adequate pain relief. NURSING MANAGEMENT CONT. 5/10/201937 PYLORIC STENOSIS
  38. 38. Fluid volume deficit related to frequent vomiting as evidenced by dry skin and mucous membrane Imbalanced nutrition less than body requirement related to vomiting as evidenced by weight loss. Impaired skin integrity related to surgery as evidenced by observation NURSING DIAGNOSIS : 5/10/201938 PYLORIC STENOSIS
  39. 39. Anxiety of parents related to hospitalization and surgery of child as evidenced by frequent questioning of parents Risk for injury related to postoperative complications NURSING DIAGNOSIS CONT. 5/10/201939 PYLORIC STENOSIS
  40. 40. 5/10/2019PYLORIC STENOSIS40
  41. 41. RESEARCH ARTICLE 5/10/2019PYLORIC STENOSIS41  Nitric oxide synthase activity in infantile hypertrophic pyloric stenosis: Marie J, Mailleux P, Schiffman S, Jacqueus J.  A research was done to study pyloric tissue from 9 infants with infantile hypertrophic pyloric stenosis and 7 as control infants.  Result: Nicotinamiide adenine dinucleotide phosphate diaphoresis activity was restricted to enteric nervous system and blood vessel.
  42. 42. 5/10/2019PYLORIC STENOSIS42  In the pyloric tissue from the control patient intense diaphorase activity was seen, whereas in pyloric tissues of patient with infantile hypertrophic pyloric stenosis there was no diaphorase activity.  Conclusion: study suggested that a lack of nitric oxide synthase in pyloric tissue is responsible for pyloro-spasm in infantile hypertrophic pyloric stenosis.
  43. 43. RECAPITULATION 5/10/2019PYLORIC STENOSIS43  Define pyloric stenosis?  Explain the causes and risk factors of pyloric stenosis?  Describe the pathophysiology of pyloric stenosis?  Enumerate clinical features of pyloric stenosis?  Enlist the diagnostic evaluation for pyloric stenosis?  Explain the management of pyloric stenosis?  Enumerate the complications of pyloric stenosis?
  44. 44. 5/10/2019PYLORIC STENOSIS44
  45. 45. DOUBT..???? 5/10/2019PYLORIC STENOSIS45
  46. 46. ASSIGNMENT 5/10/2019PYLORIC STENOSIS46  Write an assignment on nursing management of pyloric stenosis including pre and postoperative management.  Date of submission: 13/5/19  Time of submission: Before 4 pm  Place of submission: I yr M.Sc (N) classroom  Total Marks: 10  Criteria for evaluation.  Content :8 marks  Neatness: 2 mark
  47. 47. 5/10/2019PYLORIC STENOSIS47  Williams and Wilkins. Lippincott manual of nursing practice, 10 edition. Wolter kluwer publication. New delhi:2013  Lawrence J. Brandt. Clinical practice of gastroenterology. Volume 2. current medicine Inc. Publication. USA:1999  A Parthasarathy. IAP textbook of paediatrics. 6 edition. Jaypee publication. New Delhi.  Forfar, Arneil. Forfar and arneil’s textbook of paediatrics. Churchill publication:2008  Ignatanicious, Workman. Medical surgical nursing patient centered collaborative care. 7 edition. Elsevier publication. USA:2007  S N Chungh. Textbook of medicine for MBBS. 2 edition. India: Arya publication:2013  Vanderwinder J, Pierre MD, Schiffman SN. Nitric oxide synthase activity in infantile htpertrophic pyloric stenosis. N Enge J med 1992; 237:511-5. Available from: DOI: 10.1056/NEJM19920820327082
  48. 48. 5/10/2019PYLORIC STENOSIS48

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