Having a healthy intestine can help your little one grow and develop properly. Both the large intestine and the small intestine are responsible for further digesting food after leaving the stomach and absorbing nutrients. However, what happens if a baby experiences thickening of the small intestine or what is known as pyloric stenosis?
Definition
The pylorus is a muscle at the end of the stomach and intestines. When the pylorus thickens, food cannot pass through. Enlargement of the pylorus causes narrowing (stenosis) of the opening from the stomach to the intestines, which blocks stomach contents from entering the intestines.
In other words, pyloric stenosis is a thickening or swelling of the pylorus that causes severe and forceful vomiting in the first few months of life. It is also called infantile hypertrophic pyloric stenosis. This problem occurs in newborns. The full name of this condition is hypertrophic pyloric stenosis (HPS). Hypertrophy means thickening. This condition can cause projectile vomiting and can lead to dehydration in infants .
Normally, a muscular valve (pylorus) between the stomach and small intestine keeps food in the stomach until it is ready for the next stage of digestion. In pyloric stenosis, the muscles of the pylorus thicken and become abnormally large, blocking food from reaching the small intestine.
This condition can cause severe vomiting, dehydration, and weight loss . Babies with this condition may seem hungry all the time.
Symptom
Signs of pyloric thickening usually appear within three to five weeks of birth. Pyloric stenosis is rare in infants older than 3 months.
Some of the symptoms include:
Vomiting After Eating
The baby may vomit forcefully, expelling breast milk or formula several feet away (projectile vomiting). The vomiting may be mild at first and gradually become more severe as the pyloric opening narrows. The vomitus sometimes contains blood.
Constant Hunger
Babies with pyloric stenosis often want to eat immediately after vomiting.
Stomach Contractions
You may notice wave-like contractions (peristalsis) rippling in your baby’s upper abdomen immediately after feeding, but before vomiting. This is caused by the stomach muscles trying to force food through the narrowed pylorus.
Dehydration
Your baby may cry without tears or become lethargic. You may find yourself changing fewer wet diapers or diapers that are not as wet as expected.
Bowel Movement Changes
Because the thickening of the pylorus prevents food from reaching the intestines, babies with this condition may experience constipation .
Weight Problems
Thickening of the pylorus can prevent the baby from gaining weight, and can sometimes cause weight loss.
Reason
The cause of small bowel thickening is unknown, but genetic and environmental factors may play a role. Pyloric stenosis is usually absent at birth and may develop later.
Risk Factors
According to the Cleveland Clinic page , risk factors for pyloric stenosis include:
- Baby’s gender : Baby boys born full term are at higher risk. It is less likely in baby girls.
- Race : This is more common in white babies, especially those of European descent.
- Family history : About 15% of babies with pyloric stenosis have a family history. A parent who has had the condition is also important. A baby’s risk is three times higher if the mother has the condition, compared to the father.
- Smoking : Babies whose mothers smoked during pregnancy are at higher risk.
- Antibiotics : Some babies who need antibiotics soon after birth may be at higher risk. Babies whose mothers took certain antibiotics late in pregnancy may also be at higher risk.
- Feeding : Some studies of formula-fed babies have shown an increased risk of pyloric stenosis. However, it is not clear whether the risk comes from the bottle or the formula. If it comes from the bottle, it may also apply to bottles with breast milk.
Frequency of Occurrence
Pyloric stenosis usually affects babies between 2 and 8 weeks of age, but can occur at any time from birth to 6 months. It is one of the most common problems requiring surgery in newborns. It affects 2-3 babies out of 1,000.
In rare cases, older children may have a pyloric obstruction (something blocking the passage through the pylorus). Usually, a stomach ulcer is the cause in older children. Or a child may have a rare disorder such as eosinophilic gastroenteritis, which makes the stomach inflamed.
Diagnosis
According to The Children’s Hospital of Philadelphia , diagnosing pyloric stenosis is done after taking a careful medical and family history and performing a physical examination. Radiographic studies are also often recommended.
On examination, palpation of the abdomen may reveal a mass in the upper mid-abdominal region. This mass, consisting of an enlarged pylorus, is sometimes seen after the infant is given formula to drink. Feeling the mass by palpation is a diagnostic skill that requires much patience and experience. Often there are palpable (or even visible) peristaltic waves as the stomach attempts to force its contents through the narrowed pyloric canal.
In addition to a complete history and physical examination, certain diagnostic procedures are used to confirm the diagnosis of pyloric stenosis:
- Ultrasound : the most common imaging test used to view a thickened pylorus.
- Upper gastrointestinal (GI) test : a series of X-rays taken after the baby drinks a special contrast agent. The contrast agent illuminates the narrowed pyloric canal and shows how the stomach empties.
Traditional abdominal X-rays are not useful in diagnosing pyloric stenosis, unless needed to rule out other potential problems.
Handling
The first step in treating pyloric stenosis is to stabilize the baby by correcting dehydration and electrolyte imbalances, which can have serious effects on the baby’s development. The child will receive an intravenous (IV) line to replace fluids and salts lost through vomiting. This can usually be accomplished within about 24-48 hours. Blood tests will monitor how things are going.
Once the blood tests come back normal, the baby’s pyloromyotomy surgery will be scheduled. Surgery is needed to treat pyloric stenosis.
Your baby will not be able to breastfeed or bottle-feed until surgery to correct pyloric stenosis is performed. Many children are fussy during this time before surgery because they cannot eat, but it is important to minimize the chance of them vomiting. As a result, children with pyloric stenosis will continue to receive IV fluids to keep them hydrated before surgery.
During pyloric stenosis surgery, the team will:
- Giving your child a general anesthetic. Your child will be asleep during the surgery and will not feel pain.
- Make a small incision (cut) on the left side of the abdomen, higher than the navel.
- Performing a pyloromyotomy, making an incision in the thickened pylorus. This procedure allows food and fluid to flow from the stomach into the intestine.
The procedure usually takes less than an hour. Your child may need to stay in the hospital for one to three days after surgery. Here’s what to expect:
- Your child will begin eating formula or breast milk a few hours after surgery. They will eat small amounts at first. The surgeon will discuss your child’s feeding plan with you .
- If Parents are using formula, the team will slowly increase the volume and concentration of formula according to the child’s tolerance.
- If you are breastfeeding, your baby will get breast milk from a bottle for the first few feedings. It is important to measure the amount accurately.
Prevention
There is no way to prevent this condition. If you know that pyloric stenosis runs in your family, be sure to tell your healthcare provider. Your healthcare provider can look for signs or symptoms of the condition.
Knowing the signs and symptoms of pyloric stenosis means you can get help as soon as possible. Getting early treatment helps prevent problems like malnutrition and dehydration.
Hopefully the information above is useful!
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Republished with permission from theAsianparent Indonesia
