Summary about Disease
Infantile hypertrophic pyloric stenosis (IHPS) is a condition affecting infants, typically between 2 and 8 weeks of age, in which the pylorus (the muscular valve between the stomach and small intestine) thickens and narrows. This thickening obstructs the passage of food from the stomach into the small intestine, leading to forceful vomiting. It requires surgical correction.
Symptoms
Forceful, projectile vomiting: This is the hallmark symptom, often occurring after feeding. The vomit is non-bilious (does not contain bile).
Visible peristaltic waves: Wave-like contractions of the stomach may be visible across the upper abdomen as the stomach tries to push food through the narrowed pylorus.
Dehydration: Due to frequent vomiting, infants can become dehydrated.
Failure to thrive: Weight loss or inadequate weight gain.
Constant hunger: Despite vomiting, the infant is often hungry and wants to feed again.
Decreased bowel movements: Fewer stools due to limited passage of food.
Causes
The exact cause of IHPS is unknown, but it is believed to be multifactorial, involving a combination of genetic and environmental factors. Possible factors include:
Genetics: IHPS tends to run in families.
Erythromycin: Exposure to erythromycin in early infancy may increase the risk.
Nitric oxide synthase: Aberrant nitric oxide synthase expression may play a role
Medicine Used
IHPS is primarily treated surgically. However, prior to surgery, medical management focuses on correcting dehydration and electrolyte imbalances.
Intravenous fluids: To rehydrate the infant and correct electrolyte imbalances (e.g., potassium, sodium, chloride).
Is Communicable
No, infantile hypertrophic pyloric stenosis is not a communicable or infectious disease. It is a physical abnormality.
Precautions
There are no specific precautions that can be taken to prevent IHPS since the cause is largely unknown.
How long does an outbreak last?
IHPS is not an outbreak-related illness. It is a condition that develops individually in infants, typically within the first few weeks of life. The symptoms persist until the condition is surgically corrected.
How is it diagnosed?
Physical examination: A physician may feel a small, olive-shaped mass in the upper abdomen (the enlarged pylorus).
Ultrasound: This is the most common diagnostic test. It shows the thickened pylorus muscle.
Upper GI series (Barium swallow): X-rays taken after the infant drinks a barium solution can show the narrowed pyloric channel.
Blood tests: To assess electrolyte levels and dehydration.
Timeline of Symptoms
Typically starts between 2 and 8 weeks of age:
Initial symptoms: May begin with mild regurgitation or spitting up.
Progression: Vomiting becomes more forceful and projectile over days to weeks.
Dehydration and other symptoms: Develop as the condition progresses and the infant is unable to keep food down.
Important Considerations
IHPS requires prompt diagnosis and treatment to prevent severe dehydration and malnutrition.
The surgical procedure (pyloromyotomy) is usually very successful, and most infants recover fully.
Post-operative feeding is gradually reintroduced, starting with small amounts of clear liquids.
Parents should be educated about the condition, the surgical procedure, and post-operative care.