Materiały źródłowe

• #1 Pyloric Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK555931/

  Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is an uncommon condition in infants characterized by abnormal thickening of the pylorus muscles in the stomach leading to gastric outlet obstruction. […] The radiologist plays a central role in diagnosing this condition. […] The diagnosis of pyloric stenosis is being made earlier because of earlier use of sonography, so those laboratory abnormalities are now present in less than 50% of cases. […] Ultrasonography has become the standard imaging technique for diagnosing hypertrophic pyloric stenosis. It is reliable, highly sensitive, highly specific, and easily performed. An experienced ultrasonographer is necessary to diagnose pyloric stenosis. […] A pyloric wall thickness of 3 mm or greater and a pyloric channel length of 15 mm or greater are abnormal and indicate pyloric stenosis.

• #2 Pyloric stenosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pyloric-stenosis/symptoms-causes/syc-20351416

  In pyloric stenosis, the muscle of the pyloric valve thickens, blocking food from entering the baby’s small intestine. […] Pyloric stenosis (pie-LOHR-ik stuh-NOH-sis) is a narrowing of the opening between the stomach and the small intestine. This uncommon condition in infants can trap food in the stomach. […] Pyloric stenosis is treated with surgery. […] It’s important to get a prompt and accurate diagnosis. See your baby’s doctor if your baby: […] Projectile vomits after feeding. […] Is hungry again immediately after vomiting. […] Isn’t gaining weight or is losing weight.

• #3 Pyloric stenosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/680

  Pyloric stenosis is a benign condition associated with recurrent projectile non-bilious vomiting, typically in a 2- to-12-week-old male infant. […] Ultrasound shows pyloric channel length 15 mm and pyloric muscle thickness 3 mm. […] In pyloric stenosis, hypertrophy of the pyloric sphincter results in narrowing of the pyloric canal. It is the most common cause of gastric outlet obstruction in the 2- to 12-week-old age group, and leads to progressive and projectile vomiting. […] Key diagnostic factors include first-born male infant, non-bilious projectile vomiting, 2 to 12 weeks old, upper abdominal mass, and peristaltic waves. […] 1st investigations to order include chemistry panel and ultrasound abdomen.

• #4 Pyloric stenosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pyloric-stenosis/symptoms-causes/syc-20351416

  In pyloric stenosis, the muscle of the pyloric valve thickens, blocking food from entering the baby’s small intestine. […] Pyloric stenosis (pie-LOHR-ik stuh-NOH-sis) is a narrowing of the opening between the stomach and the small intestine. This uncommon condition in infants can trap food in the stomach. […] Pyloric stenosis is treated with surgery. […] It’s important to get a prompt and accurate diagnosis. See your baby’s doctor if your baby: […] Projectile vomits after feeding. […] Is hungry again immediately after vomiting. […] Isn’t gaining weight or is losing weight.

• #5 Pyloric stenosis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/680

  Pyloric stenosis is a benign condition associated with recurrent projectile nonbilious vomiting, typically in a 2- to-12-week-old male infant. […] Ultrasound shows pyloric channel length 15 mm and pyloric muscle thickness 3 mm. […] Key diagnostic factors include first-born male infant, nonbilious projectile vomiting, 2 to 12 weeks old, upper abdominal mass, and peristaltic waves. […] Other diagnostic factors include family history of pyloric stenosis, multiple formula changes, tachycardia, decreased wet diapers, dry mucous membranes, flat or depressed fontanelles, constipation, poor weight gain, and irritability. […] 1st tests to order include chemistry panel and ultrasound abdomen.

• #6 Pyloric stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pyloric-stenosis/diagnosis-treatment/drc-20351421

  Your baby’s healthcare professional will ask you questions about symptoms and do a physical exam. […] Sometimes, an olive-shaped lump can be felt on the baby’s belly. This lump is the enlarged pyloric muscle. This is more common in later stages of the condition. […] Imaging tests may be used to diagnose pyloric stenosis or rule out other conditions. These tests include: […] The standard diagnostic tool for pyloric stenosis is an ultrasound exam. This generally simple exam is done with a device placed on the baby’s belly. The ultrasound image can show enlargement of the pyloric valve. […] Your healthcare professional may order blood tests. The results can show signs of electrolyte imbalances and dehydration. […] Your child’s primary healthcare professional will likely do the exam and make a diagnosis, but you may be referred to a specialist in digestive disorders called a gastroenterologist. If the diagnosis is pyloric stenosis, you’ll be referred to a pediatric surgeon. […] What tests does my baby need? Do they require any special preparation? […] Does my baby need surgery?

• #7 Pyloric Stenosis: Sensitivity and Specificity – GetTheDiagnosis.org

  http://www.getthediagnosis.org/diagnosis/Pyloric_Stenosis.htm

  „Over the 25-year period, 901 infants underwent PM. Patients presented at a younger age, weighed more, and had a shorter length of illness in the most recent time period. Hypochloremic alkalosis was found half as frequently in the most recent time period compared to the earliest group. A palpable pyloric tumor was present in 79% of patients in the earliest time period compared with 23% in the most recent time period. Sixty-one percent of patients in the earliest group and 96% in the latest group underwent an imaging study, reflecting the referring physician’s evaluation before referral to the surgeon.” […] „The sensitivity and specificity of findings for Pyloric Stenosis are listed below.” […] „The decision analysis concluded that UGI should be the first test ordered, rather than US.” […] „Abdominal US 90% 100%” […] „Most pediatricians find that feeling pyloric mass is very insensitive.” […] „Projectile Vomiting 93% 39%” […] „Weight loss 81% 68%”

• #8 Pyloric Stenosis (HPS): Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/4524-pyloric-stenosis-hps

  Pyloric stenosis is a condition that affects your infants pylorus, the muscle at the end of the stomach leading to the small intestine. […] Pyloric stenosis symptoms include forceful vomiting, which may cause dehydration and malnourishment. […] Pyloric stenosis symptoms typically start when your baby is between 3 and 6 weeks old. […] If you notice symptoms, talk to your babys healthcare provider. […] Your babys healthcare provider will ask you about your babys eating habits and perform a physical exam. […] Sometimes, providers can feel an olive-sized lump in your babys belly (abdomen). […] Your babys provider may recommend a blood test, as well. […] If your babys healthcare provider doesnt feel a lump in their belly or wants to confirm the diagnosis, they may want to look for the pyloric stenosis on ultrasound.

• #9 Pyloric stenosis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/680

  Pyloric stenosis is a benign condition associated with recurrent projectile nonbilious vomiting, typically in a 2- to-12-week-old male infant. […] Ultrasound shows pyloric channel length 15 mm and pyloric muscle thickness 3 mm. […] Key diagnostic factors include first-born male infant, nonbilious projectile vomiting, 2 to 12 weeks old, upper abdominal mass, and peristaltic waves. […] Other diagnostic factors include family history of pyloric stenosis, multiple formula changes, tachycardia, decreased wet diapers, dry mucous membranes, flat or depressed fontanelles, constipation, poor weight gain, and irritability. […] 1st tests to order include chemistry panel and ultrasound abdomen.

• #10 Pyloric stenosis | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/pyloric-stenosis/

  The thickened pyloric muscle can be felt, especially during feeding, as a small, hard lump on the right side of the babys stomach. The childs doctor will ask lots of questions and may want to examine the baby during a feed to observe any vomiting. […] Sometimes the doctors may want to confirm the diagnosis using tests and scans. These can include an ultrasound scan, like the ones used in pregnancy, to get a picture of the thickened muscle.

• #11 Pyloric Stenosis | Causes, Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/p/pyloric-stenosis

  Careful physical examination generally reveals a firm mass, the size of an olive, in the mid-abdomen. Your physician may advise other diagnostic procedures to confirm the diagnosis and to eliminate conditions with symptoms similar to those seen in babies with pyloric stenosis. These procedures include: […] Blood tests done to evaluate dehydration and mineral imbalances […] Abdominal ultrasound — the gold standard for diagnosing pyloric stenosis. This is an imaging technique that uses high frequency sound waves and a computer to create images of blood vessels, tissues, and organs. It is used to find out the thickness and length of the pyloric muscle. […] Barium swallow / upper GI series looks at the organs making up the upper part of the digestive system (esophagus, stomach and the first section of the small intestine). A dense, chalky fluid called barium, used to coat the inside of organs so they will show up on an X-ray, is swallowed. X-rays are taken to evaluate the digestive organs. This test will also demonstrate a delayed emptying of the stomach content as well as the narrowing of the pylorus.

• #12 Pyloric Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK555931/

  Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is an uncommon condition in infants characterized by abnormal thickening of the pylorus muscles in the stomach leading to gastric outlet obstruction. […] The radiologist plays a central role in diagnosing this condition. […] The diagnosis of pyloric stenosis is being made earlier because of earlier use of sonography, so those laboratory abnormalities are now present in less than 50% of cases. […] Ultrasonography has become the standard imaging technique for diagnosing hypertrophic pyloric stenosis. It is reliable, highly sensitive, highly specific, and easily performed. An experienced ultrasonographer is necessary to diagnose pyloric stenosis. […] A pyloric wall thickness of 3 mm or greater and a pyloric channel length of 15 mm or greater are abnormal and indicate pyloric stenosis.

• #13 Pyloric Stenosis | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/pyloric-stenosis/

  Ultrasound is the ideal diagnostic modality for accurate, non-invasive and rapid confirmation of pyloric stenosis. […] Sonographic findings demonstrate: […] These important measurement values can be remembered by the mathematical pi sign (3.1415) where 3 represents the thickened muscular layer, 14 represents the transverse pyloric dimension and 15 represents the longitudinal measurement of the pyloric canal. […] Pay attention to both cine and static images. The cine images should show echogenic food content unable to pass through the thickened pylorus. Report the dimensions of the pylorus displayed on the static images.

• #14 Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3369120/

  We describe a systematic approach to the ultrasound (US) examination of the antropyloric region in children. US is the modality of choice for the diagnosis of hypertrophic pyloric stenosis (HPS). The main diagnostic criterion is a measurement of more than 3mm in thickness of the muscular layer. Abnormal elongation of the canal is characterised as greater than 12 mm in length. […] US is the first modality of choice when there is clinical suspicion of HPS, as it is non-invasive and does not use radiation, which is a crucial advantage in children. The US examination allows the radiologist to perform a brief clinical history, which can reveal essential clues to the diagnosis. […] The main diagnostic criterion is measurement of the thickness of the muscular layer. An abnormal cut off value of 3 mm in thickness has been described in the literature. The other principal sonographic size criterion is the length of the pyloric canal. Abnormal elongation of the canal is defined as greater than 12 mm in length, however this measure is more difficult to perform and for this reason is considered a less reliable criterion.

• #15 Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-012-0168-x

  We describe a systematic approach to the ultrasound (US) examination of the antropyloric region in children. US is the modality of choice for the diagnosis of hypertrophic pyloric stenosis (HPS). […] The main diagnostic criterion is a measurement of more than 3mm in thickness of the muscular layer. […] Abnormal elongation of the canal is characterised as greater than 12 mm in length. […] US is the first modality of choice when there is clinical suspicion of HPS, as it is non-invasive and does not use radiation, which is a crucial advantage in children. […] The main diagnostic criterion is measurement of the thickness of the muscular layer. An abnormal cut off value of 3 mm in thickness has been described in the literature. […] The other principal sonographic size criterion is the length of the pyloric canal. Abnormal elongation of the canal is defined as greater than 12 mm in length.

• #16 Pediatric Pyloric Stenosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/803489-workup

  Electrolytes, pH, BUN, and creatinine levels should be obtained at the same time as intravenous access in patients with pyloric stenosis. […] Hypochloremic, hypokalemic metabolic alkalosis is the classic electrolyte and acid-base imbalance of pyloric stenosis. […] Elevated unconjugated bilirubin levels may be present. […] If the clinical presentation is typical and an olive is felt, the diagnosis is almost certain. However formal ultrasonography is still recommended to evaluate the pylorus and confirm the diagnosis. […] Ultrasonography is the imaging modality of choice when evaluating a child for infantile hypertrophic pyloric stenosis (IHPS). […] The sonographic hallmark of infantile hypertrophic pyloric stenosis is the thickened pyloric muscle. […] Criteria for making the diagnosis include pyloric muscle wall thickness equal to or greater than 3 mm, and pylorus length greater than 13mm.

• #17 Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-012-0168-x

  We describe a systematic approach to the ultrasound (US) examination of the antropyloric region in children. US is the modality of choice for the diagnosis of hypertrophic pyloric stenosis (HPS). […] The main diagnostic criterion is a measurement of more than 3mm in thickness of the muscular layer. […] Abnormal elongation of the canal is characterised as greater than 12 mm in length. […] US is the first modality of choice when there is clinical suspicion of HPS, as it is non-invasive and does not use radiation, which is a crucial advantage in children. […] The main diagnostic criterion is measurement of the thickness of the muscular layer. An abnormal cut off value of 3 mm in thickness has been described in the literature. […] The other principal sonographic size criterion is the length of the pyloric canal. Abnormal elongation of the canal is defined as greater than 12 mm in length.

• #18 Immediate Emergency Department Diagnosis of Pyloric Stenosis with Point-of-care Ultrasound – The Western Journal of Emergency Medicine

  https://westjem.com/case-report/immediate-emergency-department-diagnosis-of-pyloric-stenosis-with-point-of-care-ultrasound.html

  Normal sonographic findings include a pylorus muscle thickness of less than two mm with channel length less than 15 mm. […] Pathologic findings are an increased overall diameter, thickened muscular walls (greater than three mm), an elongated pylorus (greater than 17 mm), and lack of gastric emptying. […] We present a case of hypertrophic pyloric stenosis diagnosed immediately at the bedside by an EP using point-of-care ultrasound. […] The sonographic findings are easily obtained and interpreted by EPs, even with limited training.

• #19 Pyloric Stenosis (Infant with Vomiting) | Emory School of Medicine

  https://med.emory.edu/departments/emergency-medicine/sections/ultrasound/case-of-the-month/abdominal/pyloric-stenosis.html

  Like many pathologies in pediatrics, pyloric stenosis is best evaluated with ultrasound. […] Pyloric stenosis is the most common cause of vomiting requiring surgery in infants. […] To assess for pyloric stenosis, first measure the muscular layer of pylorus in longitudinal and transverse views. 3mm thickness raises concern for hypertrophy. Then measure the length of the pyloric canal. There is a range in the radiology literature for abnormal pyloric channel length from 15 to 19 mm. […] Another way to evaluate the pylorus is to check for passage of gastric contents: if you see gastric contents moving freely through an open pylorus, then pyloric stenosis is much less likely.

• #20 Pyloric Stenosis | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/pyloric-stenosis/

  Ultrasound is the ideal diagnostic modality for accurate, non-invasive and rapid confirmation of pyloric stenosis. […] Sonographic findings demonstrate: […] These important measurement values can be remembered by the mathematical pi sign (3.1415) where 3 represents the thickened muscular layer, 14 represents the transverse pyloric dimension and 15 represents the longitudinal measurement of the pyloric canal. […] Pay attention to both cine and static images. The cine images should show echogenic food content unable to pass through the thickened pylorus. Report the dimensions of the pylorus displayed on the static images.

• #21 Pyloric stenosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pyloric-stenosis-1?lang=us

  Pyloric stenosis is relatively common, with an incidence of approximately 2-5 per 1000 births, and a male predilection (M:F ~4:1). […] Ultrasound is the modality of choice in the right clinical setting with a sensitivity of 97% and specificity of 100%. […] Diagnostic measurements include (mnemonic „number pi” – 3.1415): pyloric muscle thickness, i.e. diameter of a single muscular wall (hypoechoic component) on a transverse image: 3 mm (most accurate 3). […] With the patient’s right side down the pylorus should be watched and should not be seen to open. […] Described sonographic signs include: antral nipple sign, cervix sign, target sign, retrograde peristalsis, exaggerated peristaltic waves. […] Initial medical management is essential with rehydration and correction of electrolyte imbalances. This should be completed prior to surgical intervention. […] Treatment is surgical with a pyloromyotomy in which the pyloric muscle is divided down to the submucosa.

• #22 Pediatric Pyloric Stenosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/803489-workup

  Other sonographic signs associated with pyloric stenosis include the „antral nipple” sign, the „shoulder” sign, and the „donut” sign. […] Ultrasonography also allows for observation of peristaltic activity, differentiating between pylorospasm and true infantile hypertrophic pyloric stenosis. […] Upper GI imaging (UGI) can help to confirm the diagnosis of infantile hypertrophic pyloric stenosis but is not routinely performed unless ultrasonography is nondiagnostic. […] Upper GI endoscopy has been used as an adjunct diagnostic tool in select cases of infantile hypertrophic pyloric stenosis when other imaging tests are inconclusive or when the infant presents with atypical clinical features.

• #23 Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-012-0168-x

  In HPS the thickened muscle and elongated pylorus are fixed over time, which helps the operator to identify this condition. […] The identification of the pylorus can be difficult, but a systematic approach will improve chances of success. […] The treatment of HPS is surgical pyloromyotomy. A further US examination may be requested if vomiting persists following surgery.

• #24 Pediatric Pyloric Stenosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/803489-workup

  Other sonographic signs associated with pyloric stenosis include the „antral nipple” sign, the „shoulder” sign, and the „donut” sign. […] Ultrasonography also allows for observation of peristaltic activity, differentiating between pylorospasm and true infantile hypertrophic pyloric stenosis. […] Upper GI imaging (UGI) can help to confirm the diagnosis of infantile hypertrophic pyloric stenosis but is not routinely performed unless ultrasonography is nondiagnostic. […] Upper GI endoscopy has been used as an adjunct diagnostic tool in select cases of infantile hypertrophic pyloric stenosis when other imaging tests are inconclusive or when the infant presents with atypical clinical features.

• #25 Pyloric Stenosis (HPS): Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/4524-pyloric-stenosis-hps

  Sometimes, even a physical exam and ultrasound dont show any problems. […] If this happens, your babys provider may recommend an upper gastrointestinal (GI) series. […] Pyloric stenosis treatment involves a type of pyloroplasty surgery called pyloromyotomy. […] After diagnosing pyloric stenosis, your babys surgeon will discuss the surgery with you. […] Your babys provider will make sure your baby is properly hydrated before performing surgery. […] Your baby will likely need to stay in the hospital for one to three days after surgery. […] If your baby continues to vomit a lot, they may need more tests.

• #26 Pyloric Stenosis: Diagnosis and Treatment

  https://www.patientcareonline.com/view/pyloric-stenosis-diagnosis-and-treatment

  In the absence of a palpable pyloric mass, abdominal ultrasonography is the diagnostic test of choice. The most commonly used criteria for a positive ultrasonographic study include pyloric muscle thickness greater than 4 mm and pyloric channel length greater than 14 mm. Because these measurements are age-dependent, pyloric muscle thickness greater than 3 mm is diagnostic for PS in infants younger than 30 days. […] If ultrasonography proves nondiagnostic, an upper GI tract barium study is recommended. The classic radiographic contrast findings include a single string sign or double railroad track sign (produced by the narrowed pyloric channel), a shoulder sign (caused by the bulging of the pyloric mass into the antrum of the stomach), and delayed gastric emptying.

• #27 Pyloric Stenosis: Diagnosis and Treatment

  https://www.patientcareonline.com/view/pyloric-stenosis-diagnosis-and-treatment

  In the absence of a palpable pyloric mass, abdominal ultrasonography is the diagnostic test of choice. The most commonly used criteria for a positive ultrasonographic study include pyloric muscle thickness greater than 4 mm and pyloric channel length greater than 14 mm. Because these measurements are age-dependent, pyloric muscle thickness greater than 3 mm is diagnostic for PS in infants younger than 30 days. […] If ultrasonography proves nondiagnostic, an upper GI tract barium study is recommended. The classic radiographic contrast findings include a single string sign or double railroad track sign (produced by the narrowed pyloric channel), a shoulder sign (caused by the bulging of the pyloric mass into the antrum of the stomach), and delayed gastric emptying.

• #28 Pyloric Stenosis: Diagnosis and Treatment

  https://www.patientcareonline.com/view/pyloric-stenosis-diagnosis-and-treatment

  In the absence of a palpable pyloric mass, abdominal ultrasonography is the diagnostic test of choice. The most commonly used criteria for a positive ultrasonographic study include pyloric muscle thickness greater than 4 mm and pyloric channel length greater than 14 mm. Because these measurements are age-dependent, pyloric muscle thickness greater than 3 mm is diagnostic for PS in infants younger than 30 days. […] If ultrasonography proves nondiagnostic, an upper GI tract barium study is recommended. The classic radiographic contrast findings include a single string sign or double railroad track sign (produced by the narrowed pyloric channel), a shoulder sign (caused by the bulging of the pyloric mass into the antrum of the stomach), and delayed gastric emptying.

• #29 Pyloric Stenosis and Pyloric Atresia | Texas Children’s

  https://www.texaschildrens.org/content/conditions/pyloric-stenosis-and-pyloric-atresia

  Pyloric stenosis is diagnosed after birth. Testing may include: […] Because many of these symptoms are common to other conditions, accurate diagnosis is vital to proper treatment. […] A physical exam, checking the baby’s abdomen for a small, firm, immobile lump (described as olive shaped), which is the enlarged pylorus. […] Blood tests to check for dehydration and electrolyte levels (mineral imbalances). […] An ultrasound of the abdomen. […] X-rays, if needed, that use a chalky white liquid (barium) swallowed by the infant to better view the stomach and small intestine (known as contrast imaging). Barium x-rays can help reveal the dilated stomach, which appears as a large single bubble, and the narrowing of the pylorus, distinguishing the blockage from other intestinal obstructions.

• #30 Pyloric Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK555931/

  Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is an uncommon condition in infants characterized by abnormal thickening of the pylorus muscles in the stomach leading to gastric outlet obstruction. […] The radiologist plays a central role in diagnosing this condition. […] The diagnosis of pyloric stenosis is being made earlier because of earlier use of sonography, so those laboratory abnormalities are now present in less than 50% of cases. […] Ultrasonography has become the standard imaging technique for diagnosing hypertrophic pyloric stenosis. It is reliable, highly sensitive, highly specific, and easily performed. An experienced ultrasonographer is necessary to diagnose pyloric stenosis. […] A pyloric wall thickness of 3 mm or greater and a pyloric channel length of 15 mm or greater are abnormal and indicate pyloric stenosis.

• #31 Hypertrophic pyloric stenosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypertrophic-pyloric-stenosis/

  Hypertrophic pyloric stenosis is suspected based on history and physical examination; imaging (e.g., abdominal ultrasound) is required for confirmation. […] Indication: first-line for suspected hypertrophic pyloric stenosis. […] Hypertrophic pyloric stenosis is now usually diagnosed early, and infants generally do not present with significant electrolyte imbalances.

• #32 Pediatric Pyloric Stenosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/803489-workup

  Electrolytes, pH, BUN, and creatinine levels should be obtained at the same time as intravenous access in patients with pyloric stenosis. […] Hypochloremic, hypokalemic metabolic alkalosis is the classic electrolyte and acid-base imbalance of pyloric stenosis. […] Elevated unconjugated bilirubin levels may be present. […] If the clinical presentation is typical and an olive is felt, the diagnosis is almost certain. However formal ultrasonography is still recommended to evaluate the pylorus and confirm the diagnosis. […] Ultrasonography is the imaging modality of choice when evaluating a child for infantile hypertrophic pyloric stenosis (IHPS). […] The sonographic hallmark of infantile hypertrophic pyloric stenosis is the thickened pyloric muscle. […] Criteria for making the diagnosis include pyloric muscle wall thickness equal to or greater than 3 mm, and pylorus length greater than 13mm.

• #33 Pediatric Pyloric Stenosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/803489-workup

  Electrolytes, pH, BUN, and creatinine levels should be obtained at the same time as intravenous access in patients with pyloric stenosis. […] Hypochloremic, hypokalemic metabolic alkalosis is the classic electrolyte and acid-base imbalance of pyloric stenosis. […] Elevated unconjugated bilirubin levels may be present. […] If the clinical presentation is typical and an olive is felt, the diagnosis is almost certain. However formal ultrasonography is still recommended to evaluate the pylorus and confirm the diagnosis. […] Ultrasonography is the imaging modality of choice when evaluating a child for infantile hypertrophic pyloric stenosis (IHPS). […] The sonographic hallmark of infantile hypertrophic pyloric stenosis is the thickened pyloric muscle. […] Criteria for making the diagnosis include pyloric muscle wall thickness equal to or greater than 3 mm, and pylorus length greater than 13mm.

• #34 Pyloric stenosis in infants: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000970.htm

  Pyloric stenosis is a narrowing of the opening from the stomach into the small intestine. This article describes the condition in infants. […] The condition is often diagnosed before the baby is 6 months old. […] A physical exam may reveal: Signs of dehydration, such as dry skin and mouth, less tearing when crying, and dry diapers; Swollen belly; Olive-shaped mass when feeling the upper belly, which is the abnormal pylorus. […] Ultrasound of the abdomen may be the first imaging test. Other tests may include: Barium x-ray — reveals a swollen stomach and narrowed pylorus; Blood tests — often reveal an electrolyte imbalance.

• #35 Pyloric stenosis

  https://www.rch.org.au/clinicalguide/guideline_index/Pyloric_stenosis/

  Classical clinical and biochemical features are unlikely in early presentations of pyloric stenosis […] Abdominal ultrasound may be equivocal in early presentations, and should be repeated if there is ongoing clinical suspicion […] Surgical management can be delayed until the above are corrected […] Abdominal ultrasound (95% sensitive in the diagnosis of pyloric stenosis). If ongoing clinical suspicion despite initial equivocal ultrasound, consider repeat study.

• #36 Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3369120/

  In HPS the thickened muscle and elongated pylorus are fixed over time, which helps the operator to identify this condition. The identification of the pylorus can be difficult, but a systematic approach will improve chances of success. […] Thickening of the pyloric canal may be transient due to peristalsis or pylorospasm. If the muscle layer is 23 mm thick, and it does not relax during examination, clinical follow-up with repeat US is advisable. […] A further US examination may be requested if vomiting persists following surgery. However, the radiologist and the surgeon should be aware that the pyloric muscle may remain thickened after successful surgery and can take up to 5 months to return to normal thickness. […] Pyloric US examination is a dynamic investigation, which should be performed in a systematic way. It is important to be familiar with the normal and hypertrophied pyloric appearances, as this will provide a greater diagnostic confidence, assisting in early diagnosis and improving the management of infants with HPS.

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• #41 Pyloric Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK555931/

  Sometimes, upper endoscopy, performed by a pediatric gastroenterologist, can be used as an additional diagnostic tool in rare, select cases when the other imaging tests are nondiagnostic or when the infant presents with atypical clinical features. […] Promptly diagnosing and treating infants with pyloric stenosis requires cooperation among several in-hospital medical professionals operating as an interprofessional healthcare team. […] The emergency physicians request an emergent abdominal ultrasound. The radiologist should promptly diagnose using a stat pediatric ultrasound by a trained sonographer.

• #42 Pediatric Pyloric Stenosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/803489-workup

  Other sonographic signs associated with pyloric stenosis include the „antral nipple” sign, the „shoulder” sign, and the „donut” sign. […] Ultrasonography also allows for observation of peristaltic activity, differentiating between pylorospasm and true infantile hypertrophic pyloric stenosis. […] Upper GI imaging (UGI) can help to confirm the diagnosis of infantile hypertrophic pyloric stenosis but is not routinely performed unless ultrasonography is nondiagnostic. […] Upper GI endoscopy has been used as an adjunct diagnostic tool in select cases of infantile hypertrophic pyloric stenosis when other imaging tests are inconclusive or when the infant presents with atypical clinical features.

• #43 Pyloric stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pyloric-stenosis/diagnosis-treatment/drc-20351421

  Your baby’s healthcare professional will ask you questions about symptoms and do a physical exam. […] Sometimes, an olive-shaped lump can be felt on the baby’s belly. This lump is the enlarged pyloric muscle. This is more common in later stages of the condition. […] Imaging tests may be used to diagnose pyloric stenosis or rule out other conditions. These tests include: […] The standard diagnostic tool for pyloric stenosis is an ultrasound exam. This generally simple exam is done with a device placed on the baby’s belly. The ultrasound image can show enlargement of the pyloric valve. […] Your healthcare professional may order blood tests. The results can show signs of electrolyte imbalances and dehydration. […] Your child’s primary healthcare professional will likely do the exam and make a diagnosis, but you may be referred to a specialist in digestive disorders called a gastroenterologist. If the diagnosis is pyloric stenosis, you’ll be referred to a pediatric surgeon. […] What tests does my baby need? Do they require any special preparation? […] Does my baby need surgery?

• #44 Pyloric Stenosis (HPS): Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/4524-pyloric-stenosis-hps

  Sometimes, even a physical exam and ultrasound dont show any problems. […] If this happens, your babys provider may recommend an upper gastrointestinal (GI) series. […] Pyloric stenosis treatment involves a type of pyloroplasty surgery called pyloromyotomy. […] After diagnosing pyloric stenosis, your babys surgeon will discuss the surgery with you. […] Your babys provider will make sure your baby is properly hydrated before performing surgery. […] Your baby will likely need to stay in the hospital for one to three days after surgery. […] If your baby continues to vomit a lot, they may need more tests.

• #45 Pediatric Pyloric Stenosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/803489-workup

  Electrolytes, pH, BUN, and creatinine levels should be obtained at the same time as intravenous access in patients with pyloric stenosis. […] Hypochloremic, hypokalemic metabolic alkalosis is the classic electrolyte and acid-base imbalance of pyloric stenosis. […] Elevated unconjugated bilirubin levels may be present. […] If the clinical presentation is typical and an olive is felt, the diagnosis is almost certain. However formal ultrasonography is still recommended to evaluate the pylorus and confirm the diagnosis. […] Ultrasonography is the imaging modality of choice when evaluating a child for infantile hypertrophic pyloric stenosis (IHPS). […] The sonographic hallmark of infantile hypertrophic pyloric stenosis is the thickened pyloric muscle. […] Criteria for making the diagnosis include pyloric muscle wall thickness equal to or greater than 3 mm, and pylorus length greater than 13mm.

• #46 Pyloric stenosis

  https://www.rch.org.au/clinicalguide/guideline_index/Pyloric_stenosis/

  Classical clinical and biochemical features are unlikely in early presentations of pyloric stenosis […] Abdominal ultrasound may be equivocal in early presentations, and should be repeated if there is ongoing clinical suspicion […] Surgical management can be delayed until the above are corrected […] Abdominal ultrasound (95% sensitive in the diagnosis of pyloric stenosis). If ongoing clinical suspicion despite initial equivocal ultrasound, consider repeat study.

• #47 Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3369120/

  In HPS the thickened muscle and elongated pylorus are fixed over time, which helps the operator to identify this condition. The identification of the pylorus can be difficult, but a systematic approach will improve chances of success. […] Thickening of the pyloric canal may be transient due to peristalsis or pylorospasm. If the muscle layer is 23 mm thick, and it does not relax during examination, clinical follow-up with repeat US is advisable. […] A further US examination may be requested if vomiting persists following surgery. However, the radiologist and the surgeon should be aware that the pyloric muscle may remain thickened after successful surgery and can take up to 5 months to return to normal thickness. […] Pyloric US examination is a dynamic investigation, which should be performed in a systematic way. It is important to be familiar with the normal and hypertrophied pyloric appearances, as this will provide a greater diagnostic confidence, assisting in early diagnosis and improving the management of infants with HPS.

• #48 Pyloric Stenosis: Sensitivity and Specificity – GetTheDiagnosis.org

  http://www.getthediagnosis.org/diagnosis/Pyloric_Stenosis.htm

  „Over the 25-year period, 901 infants underwent PM. Patients presented at a younger age, weighed more, and had a shorter length of illness in the most recent time period. Hypochloremic alkalosis was found half as frequently in the most recent time period compared to the earliest group. A palpable pyloric tumor was present in 79% of patients in the earliest time period compared with 23% in the most recent time period. Sixty-one percent of patients in the earliest group and 96% in the latest group underwent an imaging study, reflecting the referring physician’s evaluation before referral to the surgeon.” […] „The sensitivity and specificity of findings for Pyloric Stenosis are listed below.” […] „The decision analysis concluded that UGI should be the first test ordered, rather than US.” […] „Abdominal US 90% 100%” […] „Most pediatricians find that feeling pyloric mass is very insensitive.” […] „Projectile Vomiting 93% 39%” […] „Weight loss 81% 68%”

• #49 Reddit – The heart of the internet

  https://www.reddit.com/r/beyondthebump/comments/3xfg27/my_experience_with_pyloric_stenosis_2monthold/

  Pyloric Stenosis is a rare condition (about 3 in 1000 infants in the U.S.) in which the muscle controlling the bottom opening of a young baby’s stomach becomes too large and eventually tightens until the stomach is fully closed and can’t drain. The condition is easy to diagnose with an ultrasound, and is easy to fix with surgery, and once the baby has recovered from surgery they will be completely well and able to eat normally. […] When my son turned 7 weeks, he suddenly – and obviously – couldn’t keep anything down for more than a few hours. […] Yet even as we were walking out the door after that appointment to go get an ultrasound to rule out Pyloric Stenosis, the doctor STILL didn’t think it could be that. […] The ultrasound tech could tell in about three seconds, and the doctor in that department confirmed the diagnosis within ten minutes and sent us to get admitted in the hospital right away.

• #50 Pyloric Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK555931/

  Sometimes, upper endoscopy, performed by a pediatric gastroenterologist, can be used as an additional diagnostic tool in rare, select cases when the other imaging tests are nondiagnostic or when the infant presents with atypical clinical features. […] Promptly diagnosing and treating infants with pyloric stenosis requires cooperation among several in-hospital medical professionals operating as an interprofessional healthcare team. […] The emergency physicians request an emergent abdominal ultrasound. The radiologist should promptly diagnose using a stat pediatric ultrasound by a trained sonographer.

• #51 Immediate Emergency Department Diagnosis of Pyloric Stenosis with Point-of-care Ultrasound – The Western Journal of Emergency Medicine

  https://westjem.com/case-report/immediate-emergency-department-diagnosis-of-pyloric-stenosis-with-point-of-care-ultrasound.html

  A 15-day-old male who was born at term presented with non-bilious projectile vomiting. […] Point-of-care ultrasound (POCUS) showed hypertrophic pyloric stenosis (HPS). […] Ultrasound (US) is recommended as the initial imaging modality for HPS. […] POCUS allows treating clinicians the ability to make this diagnosis without delay, potentially improving patient care, decreasing the need for other evaluations, and expediting therapy. […] In a prospective study pediatric EPs using POCUS after limited training were able to diagnose HPS with sensitivity and specificity approaching 100%, or as accurately as radiologists. […] General EPs using POCUS can diagnose HPS. […] EPs incorporating POCUS for HPS into their practice should allow a more rapid diagnosis, earlier therapy, and more efficient use of resources.

• #52 Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3369120/

  In HPS the thickened muscle and elongated pylorus are fixed over time, which helps the operator to identify this condition. The identification of the pylorus can be difficult, but a systematic approach will improve chances of success. […] Thickening of the pyloric canal may be transient due to peristalsis or pylorospasm. If the muscle layer is 23 mm thick, and it does not relax during examination, clinical follow-up with repeat US is advisable. […] A further US examination may be requested if vomiting persists following surgery. However, the radiologist and the surgeon should be aware that the pyloric muscle may remain thickened after successful surgery and can take up to 5 months to return to normal thickness. […] Pyloric US examination is a dynamic investigation, which should be performed in a systematic way. It is important to be familiar with the normal and hypertrophied pyloric appearances, as this will provide a greater diagnostic confidence, assisting in early diagnosis and improving the management of infants with HPS.

• #53 Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-012-0168-x

  In HPS the thickened muscle and elongated pylorus are fixed over time, which helps the operator to identify this condition. […] The identification of the pylorus can be difficult, but a systematic approach will improve chances of success. […] The treatment of HPS is surgical pyloromyotomy. A further US examination may be requested if vomiting persists following surgery.

• #54 Pyloric Stenosis

  https://healthlibrary.reading.towerhealth.org/Library/TestsProcedures/LabTests/90,P02404

  Pyloric stenosis is a problem that causes forceful vomiting in babies from birth to 6 months of age. It can lead to dehydration. […] Your child’s healthcare provider will check their health history. They will also give your child an exam. Your child may need tests to diagnose pyloric stenosis. […] These tests check if your child is dehydrated or has mineral imbalances. […] This test uses sound waves to show images of your child’s internal organs and of blood flow through various vessels. And it may show if the pylorus muscles are thickened. […] This test shows images of your child’s internal tissues, bones, and organs. […] An upper GI series looks at the organs in the upper part of your child’s digestive system. These include the esophagus, stomach, and duodenum. […] After surgery, most babies have no long-term problems from pyloric stenosis.

• #55 Pyloric Stenosis – Birth Defect Fact Sheet

  https://birthdefects.org/pyloric-stenosis/

  Another diagnostic procedure which may be used is an abdominal ultrasound to determine whether the thickness and length of the pylorus muscle are abnormal and whether it is obstructing the outflow of your babys stomach. […] Early diagnosis and treatment of Pyloric Stenosis are important to avoid life-threatening dehydration and electrolyte imbalances which can lead to shock.

• #56 Infantile hypertrophic pyloric stenosis – UpToDate

  https://www.uptodate.com/contents/infantile-hypertrophic-pyloric-stenosis

  Infantile hypertrophic pyloric stenosis (IHPS) is a disorder of young infants caused by hypertrophy of the pylorus, which can progress to near-complete obstruction of the gastric outlet, leading to forceful vomiting. […] The clinical manifestations, diagnosis, and treatment of IHPS are discussed below. […] The earlier diagnosis of IHPS might be explained by advances in diagnostic imaging or by increased awareness of the disorder among clinicians. […] The incidence of IHPS is associated with: […] Diagnostic Images: Radiograph in an infant with pyloric stenosis, Target sign in an infant with hypertrophic pyloric stenosis, Measurements of pyloric muscle in hypertrophic pyloric stenosis, Fluoroscopic upper gastrointestinal series in an infant with hypertrophic pyloric stenosis.

• #57 Pyloric Stenosis

  https://pedemmorsels.com/pyloric-stenosis/

  Infantile Hypertrophic Pyloric Stenosis is the most common condition that requires surgery in infants. […] The diagnosis, historically, is one made clinically; however, today, Ultrasound allows us to diagnosis pyloric stenosis earlier; often before the classic findings are apparent. […] Currently, the two valid methods for diagnosing Pyloric Stenosis are Upper GI and Ultrasound. […] Bottom Line: Currently, patients present earlier and are diagnosed more readily with simple techniques and this has lead to reductions in the frequency of metabolic disturbances, dehydration, and starvation. So the classic findings of Pyloric Stenosis are becoming less commonly found.

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