Congenital hypertrophic pyloric stenosis associated with
Correct Answer: Hypokalemic alkalosis
Description: Ans is 'b' i.e. Hypokalemic alkalosis Repeat from Nov 09Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria)Cause of paradoxical aciduriaInitially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is further aggravated.Hypertrophic Pyloric Stenosis (HPS)The musculature of the pylorus and adjacent antrum is grossly hypertrophied, the hypertrophy being maximum in the pylorus itself.It occurs in approximately 3 in 1000 live birth and is the most common surgical cause of vomitting in infancy.M > F (4 : 1)*Characteristically the first born male child is affected.The condition is most commonly seen at 4 wks. after birth ranging from the 3rd wk. to on rare occasion, the 7th. However, 20% of infants are symptomatic from birth, and most are symptomatic within the first 2 months after birth.Non-bilious vomiting, becoming increasingly projectile, occurs over several days to weeks. Eventually the infant will develop a nearly complete obstruction by the second to fourth week of life and will not be able to hold down even clear liquids. This invariably proceeds to severe dehydration if not t/t.These infants develop a metabolic alkalosis with severe depletion of potassium and chloride ions."The diagnosis of pyloric stenosis usually can be made on physical examination by palpation of the typical 'olive' in the right upper quadrant and the presence of visible gastric waves on the abdomen.When the olive cannot be palpated, ultrasound in experienced hands will diagnose the condition accurately in 95 percent of pts. " - Schwartz.TreatmentPyloric stenosis is never a surgical emergency although dehydration and electrolyte abnormalities may present a medical emergencyFluid resuscitation and correction of electrolyte abnormalities and metabolic alkalosis is essential before surgery.Surgery: Fredet-Ramstedt pyloromyotomy. (In it the pyloric mass is split without cutting the mucosa)Also knowAdministration of erythromycin in early infancy has been linked to the subsequent development of HPS.Jaundice may be seen in HPS, although cause is not clear.
Category:
Surgery
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