Hypertrophic Pyloric Stenosis

00:01 Welcome back.

00:02 Thanks for joining me on this discussion of hypertrophic pyloric stenosis in the section of pediatric surgery.

00:10 Hypertrophic pyloric stenosis was one of my favorite things to take care of when I was a resident because most babies do quite well and it’s extremely satisfying.

00:19 Let's take a look at the anatomy.

00:21 On the left side – left side of the screen is a normal anatomy.

00:25 You see the esophagus, the stomach tapering into the pyloric channel, and the first portion of the duodenum.

00:32 On the right side of the screen, you note that the channel – the pyloric channel, that is – is enlarged.

00:38 This is the area known as pyloric stenosis.

00:42 It is defined by the hypertrophy of the pylorus.

00:45 You can imagine then that with an obstruction there, babies may not do very well with feeds.

00:53 What's the common presentation for hypertrophic pyloric stenosis? It is more common in male babies and preterm infants and generally associated with the firstborn.

01:05 Of course, as you know, many patients don't present like textbooks.

01:08 Anything is possible.

01:12 What are some risk factors and etiology? Well, we don't really know.

01:16 It's unclear, the etiology, but it's important to recognize the associations.

01:21 Maternal smoking.

01:22 Remember, maternal smoking is associated with many, many problems in babies.

01:27 Hypertrophic pyloric stenosis is only one of them.

01:31 Once again, bottle-feeding.

01:33 Remember, our lecture on necrotizing enterocolitis and its association with bottle-fed babies? This is why many societies recommend breast-feeding.

01:44 There may be a genetic component, although we don't exactly know where the mutation lies.

01:49 There are some historical facts that some male babies also have fathers or cousins who have hypertrophic pyloric stenosis.

01:58 And there's also a loose association with the use of erythromycin.

02:03 The use of erythromycin has largely been abandoned in babies.