Hi, this is Tom, and in this episode I'm going to be going through pyloric stenosis,

and you can find notes at zero to finals.com and in the zero to finals pediatrics book,

and you can find flashcards and questions at members.0.0 tofinals.com. And at the end of the episode, we'll go through

questions so that you can test yourself on what you just heard. So let's jump straight in.

Pyloric stenosis involves thickening or hypertrophy and narrowing of the pylorus, which is what connects the stomach and the duodenum.

This prevents food from passing from the stomach to the duodenum as normal.

After feeding, increasingly powerful peristalysis occurs in the stomach, which is where the

stomach contracts and tries to squeeze food into the duodenum.

In pyloric stenosis, the stomach is contracting against the narrow pylorus, meaning that it

can't push food through to the duodenum. Eventually, the peristosis

becomes so powerful that the feed is ejected into the esophagus out of the mouth and across the room.

This is called projectile vomiting. Let's go through the features of pyloric stenosis.

Pyloric stenosis typically presents before three months of age with a hungry baby that is thin,

pale and failing to thrive.

Forceful or projectile vomiting is the key presenting feature.

When examined after feeding, peristosis may be seen on observation of the abdomen.

A firm, round mass may be felt in the upper abdomen that feels like a large olive, which is caused by the

hypertrophic pylorus. Blood gas analysis shows a hypochloric, meaning a low chloride, metabolic alkalosis,

as the baby is vomiting and losing hydrochloric acid from the stomach.

Finally, let's talk about management.

Diagnosis of pyloric stenosis is made using an abdominal ultrasound scan to visualize the thickened pylorus. The definitive treatment is with

a laparoscopic pyloromy. This involves an incision made in the smooth muscle of the

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