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.