Articles  |   March 2015
ACE Question
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Education / CPD / Articles
Articles   |   March 2015
ACE Question
ASA Monitor 03 2015, Vol.79, 45.
ASA Monitor 03 2015, Vol.79, 45.
Which of the following is the most appropriate perioperative management for an otherwise healthy infant with pyloric stenosis scheduled for a pyloromyotomy?
Pyloric stenosis (PS) occurs due to the development of hypertrophic muscle at the pylorus region of the stomach resulting in gastric outlet obstruction. The prevalence of PS is estimated to be approximately 1 in 500-2,000 live births and is more common in first-born males.
Patients with PS typically present with persistent bile-free projectile vomiting at 3-6 weeks of age. Persistent vomiting results in loss of several electrolytes, including hydrogen, chloride, sodium, and potassium. Laboratory evaluation will typically reveal a hypokalemic, hypochloremic, metabolic alkalosis. If the clinical condition progresses to a state of severe dehydration, a metabolic acidosis can result. Diagnosis is achieved by palpation of an olive-sized mass in the epigastric region and confirmed by demonstration of a thickened pylorus using ultrasound or a barium study. Ultrasound is the preferred method for establishing the diagnosis; there is a suggestion in the surgical literature that the incidence of aspiration is higher in children with pyloric stenosis who receive barium for diagnosis. Treatment of PS is by surgical division of the muscles surrounding the pylorus; pyloromyotomy can be performed open or laparoscopically.
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