Hypertrophic Pyloric Stenosis

Hypertrophic pyloric stenosis is a disorder in which the pylorus muscle, which connects the stomach to the small intestine, thickens and narrows. This can result in a stomach obstruction, preventing food and drink from flowing through the small intestine (Petkar et al., 2021). The condition is thought to be a combination of genetic and environmental factors, affecting 2 to 5 out of every 1000 births each year (Garfield & Sergent, 2020). Male cases outnumber female ones by a factor of four. The White population has the highest number, while the black and Asian groups have the lowest. This paper will focus on the signs and symptoms of hypertrophic pyloric stenosis, its pathophysiology, diagnostic tests, and treatment. In addition, the paper will describe the nursing diagnosis and their rationales, and major concerns related to hypertrophic pyloric stenosis.

Vomiting, dehydration, and weight loss are the symptoms of hypertrophic pyloric stenosis. Infants will develop non-bilious vomiting as a sign and symptom of hypertrophic pyloric stenosis (Garfield & Sergent, 2020). Projectile, non-bilious vomiting is the typical presenting symptom in infants with pyloric stenosis (Petkar et al., 2021). Vomiting might happen occasionally or right after each meal. An “olive-shaped” firm, non-tender, hard pylorus, sometimes referred to as a “firm pylorus,” can be found in the right upper quadrant of babies with pyloric stenosis in many cases. Reverse peristaltic waves may also be seen by a medical professional. Infants will have signs of dehydration, which in infants are a depressed fontanelle, decreased tearing, dry mucous membranes, poor skin turgor, and lethargy (Garfield & Sergent, 2020).

The condition affects the pyrolus muscle, which thickens and enlarges, obstructing the lumen and gastric antrum. The pyloric canal of the lumen enlarges in length. The development of the condition causes the stomach to be dilated and also causes secondary obstruction (Petkar et al., 2021). The pylorus’s circular and longitudinal muscle layers exhibit significant hypertrophy and hyperplasia (Garfield & Sergent, 2020). In difficult situations, a blocked gastric outlet can cause the stomach to swell.

The diagnostic tests assist the pediatrician in making treatment decisions. They include ultrasonography, endoscopy, barium upper hand, and abdominal X-ray. Ultrasonography is the most common method of diagnosing hypertrophic pyloric stenosis (Petkar et al., 2021). It is the most dependable, simple, and extremely specific way. The Barium upper-hand test demonstrates an enlarged pylorus and delayed gastric emptying (Garfield & Sergent, 2020). Abdominal X-rays are seldom used due to their lack of sensitivity and specificity. The Abdominal X-rays findings show the presence of gas in the stomach.

Surgery is the primary treatment for hypertrophic pyloric stenosis. A surgeon conducts the surgery. Before the surgery, the patient is rehydrated for the treatment by correcting electrolyte imbalances. The surgical procedure involves making an incision in the walls of the pylorus (Garfield & Sergent, 2020). The surgery may be performed openly or laparoscopically. The surgery is done to make the muscle walls thin and unblock them. The operation takes about an hour.

The nursing diagnosis for this condition includes, firstly, the electrolyte imbalances related to vomiting as evidenced by abnormal levels of electrolytes such as sodium and chlorine in the urine (Petkar et al., 2021). The second nursing diagnosis would be weight loss related to vomiting, as evidenced by a decreased body mass index (BMI). This is because vomiting causes the loss of macronutrients essential for normal body growth and development. The third nursing diagnosis would be dehydration related to vomiting as evidenced by dry mucous membranes in the lips and ear and the patient verbalizing being frequently thirsty. This is because vomiting also causes the loss of body fluids leading to dehydration. Fourthly, anxiety related to inadequate knowledge about the disease progression is evidenced by the parents asking frequent questions.

The nursing consideration for a patient with this condition would include promoting the patient’s skin and mouth integrity, reducing anxiety associated with this condition among the family member, and improving the hydration and nutrition of the patient. Furthermore, the parents can be educated on the risks of the disease and its treatment (Petkar et al., 2021). The patients are fed intravenously until they can feed themselves.

The research has described the signs and symptoms of hypertrophic pyloric stenosis, such as vomiting, dehydration, and weight loss, its diagnostic test, namely ultrasonography, barium upper-hand, and abdominal X-ray and its treatment which is surgery (Tröbs et al., 2022). Nursing considerations are discussed, including promoting the patient’s skin and mouth integrity and reducing anxiety associated with this condition among the family members.

Garfield, K., & Sergent, S. R. (2020). Pyloric Stenosis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555931/

Petkar, B., Meshrum, K., khander, J., & sakharwade, P. (2021, December 27). A Case Report on Pyloric Stenosis in Infants; Journal of Pharmaceutical Research International. https://journaljpri.com/index.php/JPRI/article/view/6782/13573
Tröbs, R.-B., Baranski, T., Lipphaus, A., & Nissen, M. (2022). Pyloric Stenosis and Nonbilious Vomiting in Infants: Negative Base Excess and Hypercapnia—Two Opposing Points of One Scale a Comparative Case Series. Open Journal of Pediatrics, 13(1), 104–112. https://doi.org/10.4236/ojped.2023.131014