[Applause] [Music] hi this is tom from zero2finals.com in this video i'm going to be going through pyloric stenosis and you can find written notes on this topic at zerodefinals.com pyloric stenosis or in the gastroenterology section of the zero to finals pediatrics book so let's jump straight in the pyloric sphincter is a ring of smooth muscle that forms the canal between the stomach and the duodenum hypertrophy which is thickening and therefore narrowing of the pylorus is called pyloric stenosis this prevents food traveling from the stomach to the duodenum as normal after feeding there's increasingly powerful peristalsis in the stomach as the stomach tries to push food into the duodenum eventually the peristalsis becomes so powerful that it ejects food into the esophagus out of the mouth and across the room and this is described as projectile vomiting let's talk about the features pyloric stenosis typically presents in the first few weeks of life with a hungry baby that is thin pale and generally failing to thrive the classic description of vomiting that you should remember for your exams is projectile vomiting if you examine the baby after they've had a feed you may be able to see the powerful peristalsis in the stomach by observing the abdomen a firm round mass can be felt in the upper abdomen that feels like a large olive and this is caused by the hypertrophic muscle of the pylorus if you do a blood gas analysis it will show hypochloric meaning low chloride metabolic alkalosis as the baby is vomiting the hydrochloric acid away from the stomach this is a common data interpretation question in your exams so it's worth remembering this fact let's talk about the management diagnosis can be made using abdominal ultrasound to visualize the thickened pylorus and treatment involves a procedure called a laparoscopic pyloromiotomy which is known as ramstead's operation an incision is made in the smooth muscle of the pylorus to widen the canal and allow food to pass from the stomach to the geodenum as normal and the prognosis is excellent following the operation thank you for watching this video if you liked the video left a comment or subscribe to the channel thank you so much it really helps zero to finals is not just a youtube channel there's also a website with detailed notes illustrations and questions an instagram account where new questions are posted every day to help you test your knowledge books flash cards and much more i also have a personal channel where i share my thoughts and tips on learning medicine and you can find links to everything in the description of this video see you next time