pyloric stenosis

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Information about pyloric stenosis

Published on April 26, 2014

Author: rakeshsharmahite


HYPERTROPHIC PYLORIC STENOSIS : HYPERTROPHIC PYLORIC STENOSIS DR RAKESH (PG 1 ST YEAR) MODERATOR- DR N.S.CHANDEL (ASSISTANT PROFESSOR) hypertrophic pyloric stenosis:  hypertrophic pyloric stenosis PowerPoint Presentation: The incisura angularis divides the stomach into a body to the left and a pyloric portion to the right. The sulcus intermedius further divides the pyloric portion of the stomach: the pyloric vestibule to the left, denoted by an outward convexity of the greater curvature, and the pyloric antrum or pyloric canal to the right . The pyloric antrum is approximately 2.5 cm in length and terminates at the pyloric orifice and pyloric ring or sphincter. The pyloric orifice marks the opening of the stomach into the duodenum Epidemiology: Epidemiology Etiology precise etiology remains unclear : Etiology precise etiology remains unclear Pathophysiology: Pathophysiology Pathophysiology: Pathophysiology Diagnosis: Diagnosis Clinical investigation symptoms: symptoms Clinical signs: Clinical signs PowerPoint Presentation: Visible peristalsis wave progress across the abdomen , from left to the right , Differential Diagnosis: Differential Diagnosis lab: lab Imaging: Imaging radiography Ultrasonography plain film radiography : plain film radiography the huge, gas-filled stomach extending across the midline minimal air in the intestine downstream Barium upper GI study. :  Barium upper GI study. Narrowing of the pyloric channel with a double tract of barium (‘string sign ’) ). Barium upper GI study. :  Barium upper GI study . semilunar filling defects in the antrum (shoulder sign) PowerPoint Presentation: Double streaks of barium passing through the narrow pylorus . Double track sign of pyloric stenosis PowerPoint Presentation: The  mushroom sign  ( also called  Kirklin sign  or  umbrella sign    )  is a radiological sign described in  pyloric stenosis  on barium examination. This sign refers to the impression made by the hypertrophic pylorus on the duodenal cap . Mushroom sign of pyloric stenosis PowerPoint Presentation: Upper GI study revealed a "beak sign" with overhanging shadow indicated the extrinsic intramural mass at pylorus . Ultrasound scan: Ultrasound scan A : Longitudinal view of the pylorus showing oval-shaped, enlarged pyloric muscle length >14 mm and thickness >3–4 mm are considered to be pyloric stenosis . B: Sagittal view of the pyloric olive. The infant is positioned in the left anterior oblique position and scanned over the right upper quadrant, With a linear(>5 MHz) transducer. The gastric antrum will be fluid filled( unless a nasogastric tube has been placed) and hyperdynamic peristaltic waves may be seen . PowerPoint Presentation: Ultrasound is currently the imaging modality of choice that reliably establishes the diagnosis of hypertrophic pyloric stenosis . There are various sonographic parameters that can be used to arrive at the diagnosis and include pyloric length, pyloric diameter, muscle thickness and also pyloric volume. Pyloric muscle thickness of 3 mm or greater, pyloric canal length of 17 mm or greater and the absence of the passage of a peristaltic wave through the pylorus , during the period of scanning are the diagnostic ultrasound criteria. Classically seen is:  1. A ring on transverse section, resembling a ‘doughnut’ or a ‘bulls-eye’ or a ‘target’ with the echogenic pyloric canal in the center and surrounded by the hypertrophied pyloric muscle. 2. An elongated and narrowed pyloric channel.  3.  Prolapse of the redundant mucosa into the antrum creates an ‘ antral nipple sign’. 4. In many cases, an elongated pylorus that lies adjacent to and just below the gallbladder provides the initial clue to the diagnosis.  5. Other features that may be seen are retrograde or hyper-peristaltic contractions, though none of them pass through the pylorus.  PowerPoint Presentation: CERVIX SIGN The  cervix sign of pyloric stenosis  describes indentation of the pylorus into the fluid-filled antrum , seen in  pyloric stenosis . PowerPoint Presentation: ANTRAL NIPPLE SIGN Antral nipple sign ( ie , a prolapse of redundant mucosa into the antrum which creates a pseudomass ) Longitudinal ultrasonogram in a patient with hypertrophic pyloric stenosis demonstrates a redundant mucosa that creates the antral nipple sign PowerPoint Presentation: Sonographic image resembling few of the UGI study findings. White arrow: Teat sign, Yellow arrow: Beak sign; Blue arrow: Shoulder sign . PowerPoint Presentation: The  target sign of pyloric stenosis  is a sign seen due to hypertrophied hypoechoic muscle surrounding echogenic mucosa, seen in  pyloric stenosis . This is likened to that of a target . TARGET SIGN PowerPoint Presentation: PITFALLS IN DIAGNOSIS OF HYPERROPHIC PYLORIC STENOSIS Echogenic muscle at 90 degree to beam( anisotropic effect) Posteriorly oriented antropyloric canal( overdistended stomach) Prostaglandin- induced HPS( mucosal, not musocal thickening) Minimal pyloric muscle thickening ; may progess to HPS

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