PAEDIATRIC SURGERY GUIDE, Study Guides, Projects, Research of Medical Sciences

Download PAEDIATRIC SURGERY GUIDE and more Study Guides, Projects, Research Medical Sciences in PDF only on Docsity! PAEDIATRIC SURGERY congenital hypertrophic pyloric stenosis (CHPS) * Incidence: e It is the commonest cause in surgical practice for persistent vomiting in infancy. e 1 in every 400 live births, more 1%. born infant , more in males (4:1) & may be familial. * Aetiology: Immaturity of the ganglion cells — failure or delayed relaxation of pyloric sphincter. * Pthology: 1. Pylorus. Hypertrophy of the circular muscle layer of the pyloric canal which stops abruptly at the duodenum and tapers towards the body. The pylorus projects into the duodenum forming a duodenal fornix around it. 2. Stomach: first there is thickening & hypertrophy of gastric wall but later on the stomach is markedly dilated. 3. Intestine is empty and collapsed. To esophagus — . Kx (rnte\ Cardia \ \ a :| incisura anguiarig 2) +) To duodenum ge — Fi Pyloric > é — sphincter Pyloric antrum Sulcus intermedius PAEDIATRIC SURGERY congenital hypertrophic pyloric stenosis (CHPS) * Incidence: e It is the commonest cause in surgical practice for persistent vomiting in infancy. e 1 in every 400 live births, more 1%. born infant , more in males (4:1) & may be familial. * Aetiology: Immaturity of the ganglion cells — failure or delayed relaxation of pyloric sphincter. * Pthology: 1. Pylorus. Hypertrophy of the circular muscle layer of the pyloric canal which stops abruptly at the duodenum and tapers towards the body. The pylorus projects into the duodenum forming a duodenal fornix around it. 2. Stomach: first there is thickening & hypertrophy of gastric wall but later on the stomach is markedly dilated. 3. Intestine is empty and collapsed. To esophagus — . Kx (rnte\ Cardia \ \ a :| incisura anguiarig 2) +) To duodenum ge — Fi Pyloric > é — sphincter Pyloric antrum Sulcus intermedius  * Complications: Repeated vomiting leads to: 1.Loss of acid + metabolic alkalosis — tetany. 2.Hyponatraemia , hypokalaemia & hypocalcaemia due to Na, K & calcium loss respectively. 3. Dehydration. 4. Anaemia & loss of weight. 5. Respiratory obstruction & infection due to inhalation of vomitus . * Clinical Picture: 1. The condition usually manifests itself 2-4 weeks after birth. 2. The infant is constantly crying due to constant colic and hunger. 3. Vomiting: is most important prominent feature, repeated, projectile, never bile stained, contains food of previous meals or days, foul odour (Fermentation). 4. Progressive constipation with small hard rabit stool and decreasing urination. 5. Picture of complications , dehydration ,weight loss & anaemia . 6. Thick pyloric canal is felt in 90% of cases as olive, oval, firm mass at the level of L1 vertebra just to right side of middle line is diagnostic. 6. Epigastric fullness with visible peristaltic waves in the epigastrium propagating from left to right. 7. In 10% of cases haematemesis may occur due to gastritis & oesophagitis. ¢~- N.B: Any neonate presenting with repeated projectile, non bile stained vomiting, associated hunger & firm stools should by considered to have CHPS until proved otherwise.  Caterpillar sign  * Treatment: Only surgical. e Rapid preoperative preparation : > I.V fluids to correct fluid and electrolyte imbalance. > Nasogastric tube for gastric suction and gastric wash. > Treatment of respiratory infections. e Exposure : > Laparoscopic approach. > Ramstedt’s Operation: Right upper quadrant transverse incision. > Method : # Pyloromyotomy: The thick circular muscle layer in pyloric region is incised longitudinal down to the submucosa , stopping short of prepyloric vein > pyloric mucosa bulges. Ramstedt’s Pyloromyotomy te Fia. 2: Pvlorus being spread out until mucosa bulaes