Pathophysiology (Hypertrophic Pyloric Stenosis)

regu_3a_n.jpg: Example of an infant with multiple skin folds of the extremities. Following the recurrent and continuous vomiting and the impossibility to sufficiently feed him due to the hypertrophic pyloric stenosis, exsiccosis has developed. The muscular structure is visible mainly on the upper arm where a so-called standing skin fold has developed !£regu_3a_p£! (a lifted skin fold does not even out on releasing it). Multiple skin folds, a standing skin fold, enophthalmos with a diminished pressure on palpation and a sunken anterior fontanel are clinical signs of exsiccosis. regu_3b_n.jpg: 3.5-week-old patient born at term who was hospitalized due to bringing up some milk (oo). He had a continuous weight increase from day 1 to day 3 of hospitalization but had reached his original birth weight of 3265g only after 3 weeks (29.7.07). The weight stopped from day 3 to day 5 and an increasing vomiting was observed (x later xx) which was accompanied by loss of body weight from day 5 to day 8. Only after clinical and ultrasound diagnosis of hypertrophic pyloric stenosis and pyloromyotomy (OPS) there is a regular food intake and weight increase from day 13 on. This characteristic course of body weight (broken black line) which was observed by chance in a hospitalized patient can be seen and may be reconstructed usually at home depending on the behavior of the parents, the measures taken by the practitioner, and the natural history of the individual hypertrophic pyloric stenosis (I owe this picture to K. Roth, Pediatric Surgery, CH-Aarau and Baden). regu_3c_n.jpg: Potassium, chloride and bicarbonate values in 139 patients with hypertrophic pyloric stenosis (1986 through 1997). The 95% confidence interval of the normal values is marked by a frame. Due to the continuous vomiting and impossibility to feed with loss of gastric acid, a hypochloremic (and rarely, a hypopotassemic) metabolic alkalosis is also developing ( Miozzari HH. Thesis of the Medical Faculty of the University of CH-Bern).