Medication Guide App

Pyloromyotomy

WHAT YOU SHOULD KNOW:

Pyloromyotomy (Inpatient Care) Care Guide

  • Pyloric stenosis is also called infantile hypertrophic pyloric stenosis. It is caused when a muscle between the stomach and duodenum grows too large and thick. The duodenum is the part of the small intestines (bowel) that connects to the stomach. As this muscle grows, it begins to block food from being pushed from the stomach into the duodenum. In time, the muscle can grow so thick and tight that it blocks all food from going to the duodenum. Pyloric stenosis usually happens in babies who are 1 to 10 weeks old. It may happen in older babies too, but not as often.

  • A common symptom of pyloric stenosis is vomiting (spitting up) after feedings and dehydration. Vomiting may become projectile (forceful burst) as the pyloric stenosis gets worse. Vomiting usually happens 30 minutes to 1 hour after a feeding. Dehydration happens when your baby vomits and loses too much fluid and electrolytes or "salts". This is a dangerous condition for your baby. When a baby is dehydrated, the heart and blood system cannot work normally. Most babies have surgery called a pyloromyotomy to fix the pyloric stenosis.

CARE AGREEMENT:

You have the right to help plan your baby's care. Learn about your baby's health condition and how it may be treated. Discuss treatment options with your baby's caregivers to decide what care you want for your baby.

RISKS:

  • Although most babies recover quickly after a pyloromyotomy, there are always risks with surgery. Your baby may bleed more than usual or get an infection. Your baby may have low blood sugar after going off the IV or have apnea (sometimes forgets to breathe) after anesthesia. Your baby could swallow fluid into his lungs and get pneumonia. An instrument or tube could poke or cut into the stomach, intestines, or other organs during surgery. Your baby's surgery wound could open up and need to be repaired by caregivers. The pylorus muscle could overgrow again or your baby's stomach or intestines could remain blocked. Your baby may need surgery again if he has either of these problems. Your baby could die.

  • Even after surgery, your baby may continue to vomit for a few days. This may be caused by swelling from the surgery. Your baby could have a problem with gastroesophageal reflux (GERD). This means that your baby's feedings mix with stomach acid and leak back up the esophagus. This causes burning and discomfort for your baby.

WHILE YOU ARE HERE:

Before Your Baby's Surgery:

  • Informed Consent:

    • You have the right to understand your baby's health problem. You should understand what tests, treatments, or procedures may be done to treat your baby's problem. Your baby's caregiver should also tell you about the risks and benefits of each treatment.

    • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your baby. A consent form is a legal paper that gives caregivers permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your baby. Your baby's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered.

  • Call Button: A call button will be in your baby's hospital room. You should use the call button if your baby is having problems and a caregiver is needed. You can also use the call button if you have questions for a caregiver. Be sure to keep the call button near your baby's bed at all times.

  • Daily Weights: Caregivers will weigh your baby each day on a special weight scale. This helps your caregivers know if your baby is losing or gaining weight. Caregivers will try to weigh your baby at about the same time each day.

  • Heart Monitor: This is a machine used to see how your baby's heart is handling the pyloric stenosis. 3 or 5 sticky pads are placed on your baby's chest. Each pad has a wire that is hooked to a TV-type screen or to a small portable box. This screen or box shows a picture of your baby's heartbeat. Caregivers watch this picture to make sure your baby's heart is doing well.

  • IV:

    • An IV is a tiny tube placed in your baby's vein for giving medicine or liquids. The IV may be put in your baby's arm, hand, ankle, foot, or head. This tube is connected to tubing and a bag of liquid near your baby's crib.

    • If your baby has been vomiting a lot, his body may be low on body fluid and salts. Your baby may need an IV to fill his blood full of enough fluid and salts. Babies must have a normal amount of fluids and salts before they can go to surgery. Your baby may need an IV for 1 or 2 days before he is ready to go to surgery. Caregivers may leave the IV in after surgery until your baby is drinking enough from a bottle or breast.

  • Intake and Output (I&O): Your baby's caregivers will need to know how much liquid your baby is getting and losing. They will carefully keep track of all IV fluids that your baby gets. They will need to know about any liquid that comes out of your baby. This includes all your baby's wet diapers, bowel movements (BM), and vomit. Save all your baby's diapers so caregivers can weigh and test the urine or BM.

  • NPO:

    • Although some babies may be allowed to feed in small amounts, most are NPO while waiting for surgery. NPO means "nothing by mouth". Your baby's IV has sugar in it that feeds your baby. This may make your baby a little less hungry. Let your baby suck on a pacifier if he is fussy or acting hungry. Do not give your baby anything to eat or drink if he is NPO.

    • If you are a breast feeding mother: Pump your breasts while your baby is NPO. This will help your breasts to keep making milk even while your baby is not drinking it. Ask caregivers for information about pumping and saving breastmilk. Keep your breastmilk in a freezer until your baby is able to eat again. Ask caregivers if you have any questions or concerns about breast feeding and storing your milk.

  • NG Tube: This may also be called a nasogastric tube. A caregiver may place this tube in your baby's nose and down to the stomach. This tube will be used for suction (vacuum) and keeping your baby's stomach empty. This is commonly used before, during, and a short time after surgery. Do not let your baby pull on the NG tube. Tell a caregiver if the tube comes out of your baby's nose.

  • Pulse Oximeter: This machine shows caregivers how much oxygen is in your baby's blood. A cord with a clip or sticky strip is placed on your baby's foot, toe, hand, finger, or earlobe. Tell a caregiver if the sticky strip or clip comes off of your baby. The machine will sound an alarm if the machine cannot read the oxygen level. It will also alarm if your baby needs extra oxygen. Tell a caregiver if the machine is alarming. Never turn the pulse oximeter off.

  • Restraints: These are cloth bands used to tie your baby's wrists or ankles to the sides of the hospital bed. These restraints are used to keep your baby from pulling or kicking out any special tubes he may have. Caregivers will check on you and your baby often to make sure your baby is safe. They will check to see that all your baby's needs are being met while your baby is restrained. Restraints should only be used for a short time. They will be taken off when there is less chance that your baby will pull or kick the tubes out.

  • Sitting Up: Caregivers may sit your baby up in an infant seat or prop him up in bed. This may keep him from choking if he vomits and keep him more comfortable.

  • Vital Signs: This may include taking your baby's temperature, pulse (heartbeats), respiration (breaths), and blood pressure. Your baby's temperature may be taken in the mouth, ear, armpit, or rectum (rear-end). Caregivers may also listen to your baby's heart and lungs by using a stethoscope.

  • Tests: Your baby may have 1 or more of the following tests:

    • Blood Tests:

      • Your baby may need blood taken for tests. The blood may be taken from your baby's arm, hand, finger, heel, or foot. Caregivers will especially want to know about your baby's electrolytes. Electrolytes are blood "salts". Some of these electrolytes are called sodium, potassium, and chloride. Electrolytes keep your baby's body working normally.

      • When babies vomit often, they lose too much body fluid and electrolytes. Low body fluid and low or unbalanced electrolytes can cause serious problems with the heart and blood system. Babies that are too dehydrated may die. Your baby may need an IV to get his fluid and electrolytes back to normal.

    • Ultrasound:

      • This test uses sound waves to show pictures of the inside of your baby's abdomen (belly). Your baby will lie down on a soft table in a quiet room. A caregiver will put warm clear gel on your baby's belly. The caregiver will gently move a small probe (camera) across your baby's belly to take pictures.

      • During the ultrasound, caregivers will look at your baby's stomach and small intestines. They will look to see if the pyloric muscle is longer or thicker than it should be. You may stay with your baby during the test. You can help caregivers by keeping your baby calm and still. Bring a pacifier for your baby to suck on. Sucking is a way that babies comfort themselves. If your baby has a favorite stuffed animal or blanket, bring it to keep near your baby during the test.

    • Upper GI:

      • An x-ray machine is used to take pictures of your baby's esophagus, stomach, and duodenum. Your baby will lie on a flat table. Your baby will drink a chalky liquid (barium) to help his organs show up better on x-ray. While your baby drinks barium from a bottle, x-ray pictures are taken. Caregivers will look at the x-ray pictures on a TV-like screen to see how the barium fills your baby's stomach. Caregivers may give barium through an NG tube or syringe if your baby cannot drink it from a bottle.

      • Caregivers may take more pictures after your baby has finished drinking. If your baby has pyloric stenosis, x-rays may show that his stomach has problems passing barium to the duodenum. Ask caregivers if you can stay in the x-ray room while the test is being done on your baby. If you stay in the room, you may be asked to wear a special lead apron to protect you from the x-rays. If you are pregnant, stay out of the room since x-rays may be harmful to unborn babies.

  • PreOp Care: This is the care your baby gets right before surgery. Your baby may be given medicines right before surgery. One of the medicines may make your baby feel sleepy and more relaxed. Your baby may also be given antibiotics to help fight infection. Your baby will be taken on a cart or crib to the room where surgery will be done. Your baby may have special tubes put in him and equipment attached to him during this time. Caregivers will stay with your baby all the time to make sure he is warm, safe, and comfortable.

  • General Anesthesia: This medicine puts your baby to sleep and makes him comfortable during surgery. It may be given in an IV or as a gas through a facemask. This medicine may also go through a tube placed in your baby's mouth and throat. A mouth tube is called an endotracheal tube or "ET tube".

During Your Baby's Surgery:

  • A caregiver will clean your baby's chest and belly with special soap. This soap may make your baby's skin yellow, but it is cleaned off later. Sheets are put over your baby to keep the surgery area clean. Caregivers may make a 1 to 2 inch incision (cut) in the right side of your baby's upper belly. Caregivers may make a smaller incision (cut) at the edge or inside your baby's belly button, instead of his upper belly.

  • The muscle that becomes thick and tight is called the pyloric muscle (or valve). During surgery, caregivers cut into the thick, tight pyloric muscle. The muscle is spread apart and relaxed so that your baby's stomach can easily pass food to his duodenum. Caregiver may close the wound underneath your baby's skin with stitches. These stitches will dissolve (melt away) in time and do not need to be removed. Your baby may get steristrips (thin strips of tape) to hold the skin on the outside of his belly together.

Waiting Room:

This room is where you and your family can wait until your baby is ready for visitors after surgery. Your baby's caregiver will find you there to let you know how the surgery went. If you or your family leave the hospital, leave a phone number where you can be reached.

After Your Baby's Surgery:

Your baby may be taken to an ICU or a recovery area until he wakes up and is comfortable. Then, he may be taken to a regular hospital room. You may be able to visit your baby after caregivers get him settled after surgery.

  • Activity: Your baby may be sleepy after surgery, then wake up hungry. Let your baby's caregivers know when your baby is awake and acting hungry.

  • Daily Weights: Caregivers may continue to weigh your baby each day. This will help them to know if your baby is losing or gaining weight after surgery.

  • Emotional Support: You may stay with your baby for comfort and support. Your baby may need to stay in the hospital for 2 or 3 days after surgery. Ask caregivers if another family member can stay with your baby when you cannot be there. Bring in something from home that your baby likes, such as a blanket or favorite toy.

  • Eating:

    • Once your baby is awake and alert after surgery, caregivers may start feeding him. Caregivers usually start feedings 3 to 12 hours after surgery. They may start by giving your baby glucose (sugar) water or water with electrolytes in it. If your baby eats OK, caregivers will give him watered-down breast milk or formula. If your baby continues to eat OK, caregivers will give him regular breast milk or formula. If you are a breast feeding mother, ask caregivers when you can breast feed your baby after surgery.

    • Caregivers may leave an NG tube in your baby's stomach for the first 2 or 3 feedings. They may want to see if there is left-over milk or formula in the stomach before each new feeding. Once your baby is feeding well, caregivers will take out the NG tube.

  • I&O:

    • Caregivers may keep your baby on I&O after surgery. They will need to measure all liquid that goes in your baby's body. This includes breast milk or formula and IV fluid. If you feed your baby from a bottle, tell caregivers how much formula or breast milk your baby eats. Save the bottle for the caregiver to look at after the feeding. If you breast feed your baby, tell caregivers how long you fed your baby from each breast. Write down the amount of time per breast plus what time you started the feeding. This way, you will not forget.

    • Caregivers will need to measure all fluid that goes out of your baby's body. This includes wet diapers, BMs, and vomit. Save any diapers you change so caregivers can weigh and measure them. Tell caregivers if your baby vomits during or after a feeding. They may need to estimate (guess) how much your baby vomited.

  • Medicines:

    • Antibiotics: This may be given to help your baby fight an infection caused by a germ called bacteria (bak-TEER-e-uh).

    • Pain Medicine: Caregivers may give medicine to help your baby's pain decrease or go away. Tell a caregiver if you think your baby's pain does not go away or comes back after taking this medicine.

  • Sitting Up: Caregivers may put your baby in an infant seat or prop him up in bed after feedings. This may help your baby's stomach push food to the duodenum. It may make your baby feel more comfortable. If your baby spits up after a feeding, sitting up may help keep him from choking.

  • Vomiting: Your baby may vomit after feedings, even after the pyloric stenosis has been fixed. This may be caused by swelling around the surgery area. Do not be scared if your baby is vomiting after surgery. Your baby's caregivers will watch your baby carefully. Babies may vomit a few times for the first 2 or 3 days after surgery, and sometimes up to 5 days. Caregivers may give your baby small feedings more often to help your baby keep his milk or formula down better.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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