quotePyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy.↗
▶Ep 21 · 0:31
clinicalPyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy↗
▶Ep 21 · 0:37
clinicalPyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age↗
▶Ep 21 · 0:46
epidemiologicalPyloric stenosis is more common in males↗
▶Ep 21 · 0:49
epidemiologicalThere is increased risk for first born infants with a positive family history↗
▶Ep 21 · 1:04
clinicalPatients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life↗
▶Ep 21 · 1:12
clinicalInfants with pyloric stenosis are otherwise well appearing and hungry after vomiting↗
▶Ep 21 · 1:16
clinicalEmesis in pyloric stenosis will progress until it is projectile↗
▶Ep 21 · 1:24
clinicalHyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation↗
▶Ep 21 · 2:00
guidelineBilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus↗
▶Ep 21 · 2:50
clinicalUltrasound is the gold standard for diagnosing pyloric stenosis↗
▶Ep 21 · 2:55
clinicalPyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater↗
▶Ep 21 · 2:55
quoteEasy way to remember this is to remember the value of pi as 314, 3 millimeters thick and 4 millimeters long, and anything above this is diagnostic.↗
▶Ep 21 · 3:19
quoteThe classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis.↗
▶Ep 21 · 3:19
clinicalThe classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis↗
▶Ep 21 · 3:29
clinicalProlonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis↗
▶Ep 21 · 3:41
clinicalThe kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water↗
▶Ep 21 · 3:56
clinicalIn later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis↗
▶Ep 21 · 4:17
guidelineIn the US, pyloromyotomy is the standard of care for pyloric stenosis↗
▶Ep 21 · 4:22
clinicalIn some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90%↗
▶Ep 21 · 4:41
guidelineCincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis↗
▶Ep 21 · 4:41
quoteAt Cincinnati Children's, we follow a protocol published by the Children's Mercy Group in Kansas City that takes the guesswork out of how many bonuses to give and how frequently you should draw labs.↗
▶Ep 21 · 5:01
guidelineIf chloride is less than 85, give 3 boluses separated by an hour and then recheck labs↗
▶Ep 21 · 5:10
guidelineIf chloride is between 85 and 97, give two boluses↗
▶Ep 21 · 5:15
guidelineIf chloride is greater than 97, give 1 bolus↗
▶Ep 21 · 5:24
guidelineIf bicarbonate is greater than 40, give 3 boluses↗
▶Ep 21 · 5:29
guidelineIf bicarbonate is greater than or equal to 33, give 2 boluses↗
▶Ep 21 · 5:48
guidelinePrior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30↗
▶Ep 21 · 7:00
clinicalThe proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus↗
▶Ep 21 · 7:07
clinicalThe distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction↗
▶Ep 21 · 8:18
clinicalAfter the pyloromyotomy is completed, the submucosa should bulge into the myotomy site↗
▶Ep 21 · 8:25
clinicalAfter adequate pyloromyotomy, each side of the pylorus should move independently↗
▶Ep 21 · 8:42
clinicalComplications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias↗
▶Ep 21 · 8:52
clinicalThere is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches↗
▶Ep 21 · 9:17
clinicalFor mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall↗
▶Ep 21 · 10:05
clinicalMost infants can be fed immediately after pyloromyotomy↗
▶Ep 21 · 10:13
clinicalEvidence supports ad-lib feeds after pyloromyotomy; once the infant is alert and awake, these infants achieve full feeds sooner with no increase in readmission rates↗
▶Ep 21 · 10:32
clinicalSmall episodes of emesis after pyloromyotomy are almost to be expected as the stomach recovers from days to weeks of progressive dilation↗
▶Ep 21 · 10:44
clinicalOdds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter↗
Bhargava's statements about Intestinal Rehab39 statements
clinicalPyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy↗
▶Ep 30 · 0:31
quotePyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy.↗
▶Ep 30 · 0:37
clinicalPyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age↗
▶Ep 30 · 0:46
epidemiologicalPyloric stenosis is more common in males↗
▶Ep 30 · 0:49
epidemiologicalThere is increased risk for first born infants with a positive family history↗
▶Ep 30 · 1:04
clinicalPatients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life↗
▶Ep 30 · 1:12
clinicalInfants with pyloric stenosis are otherwise well appearing and hungry after vomiting↗
▶Ep 30 · 1:16
clinicalEmesis in pyloric stenosis will progress until it is projectile↗
▶Ep 30 · 1:24
clinicalHyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation↗
▶Ep 30 · 2:00
guidelineBilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus↗
▶Ep 30 · 2:50
clinicalUltrasound is the gold standard for diagnosing pyloric stenosis↗
▶Ep 30 · 2:55
quoteEasy way to remember this is to remember the value of pi as 314, 3 millimeters thick and 4 millimeters long, and anything above this is diagnostic.↗
▶Ep 30 · 2:55
clinicalPyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater↗
▶Ep 30 · 3:19
clinicalThe classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis↗
▶Ep 30 · 3:19
quoteThe classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis.↗
▶Ep 30 · 3:29
clinicalProlonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis↗
▶Ep 30 · 3:41
clinicalThe kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water↗
▶Ep 30 · 3:56
clinicalIn later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis↗
▶Ep 30 · 4:17
guidelineIn the US, pyloromyotomy is the standard of care for pyloric stenosis↗
▶Ep 30 · 4:22
clinicalIn some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90%↗
▶Ep 30 · 4:41
quoteAt Cincinnati Children's, we follow a protocol published by the Children's Mercy Group in Kansas City that takes the guesswork out of how many bonuses to give and how frequently you should draw labs.↗
▶Ep 30 · 4:41
guidelineCincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis↗
▶Ep 30 · 5:01
guidelineIf chloride is less than 85, give 3 boluses separated by an hour and then recheck labs↗
▶Ep 30 · 5:10
guidelineIf chloride is between 85 and 97, give two boluses↗
▶Ep 30 · 5:15
guidelineIf chloride is greater than 97, give 1 bolus↗
▶Ep 30 · 5:24
guidelineIf bicarbonate is greater than 40, give 3 boluses↗
▶Ep 30 · 5:29
guidelineIf bicarbonate is greater than or equal to 33, give 2 boluses↗
▶Ep 30 · 5:48
guidelinePrior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30↗
▶Ep 30 · 7:00
clinicalThe proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus↗
▶Ep 30 · 7:07
clinicalThe distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction↗
▶Ep 30 · 8:18
clinicalAfter the pyloromyotomy is completed, the submucosa should bulge into the myotomy site↗
▶Ep 30 · 8:25
clinicalAfter adequate pyloromyotomy, each side of the pylorus should move independently↗
▶Ep 30 · 8:42
clinicalComplications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias↗
▶Ep 30 · 8:52
clinicalThere is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches↗
▶Ep 30 · 9:17
clinicalFor mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall↗
▶Ep 30 · 10:05
clinicalMost infants can be fed immediately after pyloromyotomy↗
▶Ep 30 · 10:13
clinicalEvidence supports ad-lib feeds after pyloromyotomy; once the infant is alert and awake, these infants achieve full feeds sooner with no increase in readmission rates↗
▶Ep 30 · 10:32
clinicalSmall episodes of emesis after pyloromyotomy are almost to be expected as the stomach recovers from days to weeks of progressive dilation↗
▶Ep 30 · 10:44
clinicalOdds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter↗
Bhargava's statements about Pyloric Stenosis39 statements
clinicalPyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy↗
▶Ep 4 · 0:31
quotePyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy.↗
▶Ep 4 · 0:37
clinicalPyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age↗
▶Ep 4 · 0:46
epidemiologicalPyloric stenosis is more common in males↗
▶Ep 4 · 0:49
epidemiologicalThere is increased risk for first born infants with a positive family history↗
▶Ep 4 · 1:04
clinicalPatients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life↗
▶Ep 4 · 1:12
clinicalInfants with pyloric stenosis are otherwise well appearing and hungry after vomiting↗
▶Ep 4 · 1:16
clinicalEmesis in pyloric stenosis will progress until it is projectile↗
▶Ep 4 · 1:24
clinicalHyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation↗
▶Ep 4 · 2:00
guidelineBilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus↗
▶Ep 4 · 2:50
clinicalUltrasound is the gold standard for diagnosing pyloric stenosis↗
▶Ep 4 · 2:55
quoteEasy way to remember this is to remember the value of pi as 314, 3 millimeters thick and 4 millimeters long, and anything above this is diagnostic.↗
▶Ep 4 · 2:55
clinicalPyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater↗
▶Ep 4 · 3:19
quoteThe classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis.↗
▶Ep 4 · 3:19
clinicalThe classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis↗
▶Ep 4 · 3:29
clinicalProlonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis↗
▶Ep 4 · 3:41
clinicalThe kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water↗
▶Ep 4 · 3:56
clinicalIn later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis↗
▶Ep 4 · 4:17
guidelineIn the US, pyloromyotomy is the standard of care for pyloric stenosis↗
▶Ep 4 · 4:22
clinicalIn some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90%↗
▶Ep 4 · 4:41
quoteAt Cincinnati Children's, we follow a protocol published by the Children's Mercy Group in Kansas City that takes the guesswork out of how many bonuses to give and how frequently you should draw labs.↗
▶Ep 4 · 4:41
guidelineCincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis↗
▶Ep 4 · 5:01
guidelineIf chloride is less than 85, give 3 boluses separated by an hour and then recheck labs↗
▶Ep 4 · 5:10
guidelineIf chloride is between 85 and 97, give two boluses↗
▶Ep 4 · 5:15
guidelineIf chloride is greater than 97, give 1 bolus↗
▶Ep 4 · 5:24
guidelineIf bicarbonate is greater than 40, give 3 boluses↗
▶Ep 4 · 5:29
guidelineIf bicarbonate is greater than or equal to 33, give 2 boluses↗
▶Ep 4 · 5:48
guidelinePrior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30↗
▶Ep 4 · 7:00
clinicalThe proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus↗
▶Ep 4 · 7:07
clinicalThe distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction↗
▶Ep 4 · 8:18
clinicalAfter the pyloromyotomy is completed, the submucosa should bulge into the myotomy site↗
▶Ep 4 · 8:25
clinicalAfter adequate pyloromyotomy, each side of the pylorus should move independently↗
▶Ep 4 · 8:42
clinicalComplications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias↗
▶Ep 4 · 8:52
clinicalThere is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches↗
▶Ep 4 · 9:17
clinicalFor mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall↗
▶Ep 4 · 10:05
clinicalMost infants can be fed immediately after pyloromyotomy↗
▶Ep 4 · 10:13
clinicalEvidence supports ad-lib feeds after pyloromyotomy; once the infant is alert and awake, these infants achieve full feeds sooner with no increase in readmission rates↗
▶Ep 4 · 10:32
clinicalSmall episodes of emesis after pyloromyotomy are almost to be expected as the stomach recovers from days to weeks of progressive dilation↗
▶Ep 4 · 10:44
clinicalOdds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter↗
Bhargava's statements about Single Ventricle / HLHS39 statements
quotePyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy.↗
▶Ep 27 · 0:31
clinicalPyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy↗
▶Ep 27 · 0:37
clinicalPyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age↗
▶Ep 27 · 0:46
epidemiologicalPyloric stenosis is more common in males↗
▶Ep 27 · 0:49
epidemiologicalThere is increased risk for first born infants with a positive family history↗
▶Ep 27 · 1:04
clinicalPatients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life↗
▶Ep 27 · 1:12
clinicalInfants with pyloric stenosis are otherwise well appearing and hungry after vomiting↗
▶Ep 27 · 1:16
clinicalEmesis in pyloric stenosis will progress until it is projectile↗
▶Ep 27 · 1:24
clinicalHyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation↗
▶Ep 27 · 2:00
guidelineBilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus↗
▶Ep 27 · 2:50
clinicalUltrasound is the gold standard for diagnosing pyloric stenosis↗
▶Ep 27 · 2:55
clinicalPyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater↗
▶Ep 27 · 2:55
quoteEasy way to remember this is to remember the value of pi as 314, 3 millimeters thick and 4 millimeters long, and anything above this is diagnostic.↗
▶Ep 27 · 3:19
quoteThe classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis.↗
▶Ep 27 · 3:19
clinicalThe classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis↗
▶Ep 27 · 3:29
clinicalProlonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis↗
▶Ep 27 · 3:41
clinicalThe kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water↗
▶Ep 27 · 3:56
clinicalIn later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis↗
▶Ep 27 · 4:17
guidelineIn the US, pyloromyotomy is the standard of care for pyloric stenosis↗
▶Ep 27 · 4:22
clinicalIn some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90%↗
▶Ep 27 · 4:41
quoteAt Cincinnati Children's, we follow a protocol published by the Children's Mercy Group in Kansas City that takes the guesswork out of how many bonuses to give and how frequently you should draw labs.↗
▶Ep 27 · 4:41
guidelineCincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis↗
▶Ep 27 · 5:01
guidelineIf chloride is less than 85, give 3 boluses separated by an hour and then recheck labs↗
▶Ep 27 · 5:10
guidelineIf chloride is between 85 and 97, give two boluses↗
▶Ep 27 · 5:15
guidelineIf chloride is greater than 97, give 1 bolus↗
▶Ep 27 · 5:24
guidelineIf bicarbonate is greater than 40, give 3 boluses↗
▶Ep 27 · 5:29
guidelineIf bicarbonate is greater than or equal to 33, give 2 boluses↗
▶Ep 27 · 5:48
guidelinePrior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30↗
▶Ep 27 · 7:00
clinicalThe proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus↗
▶Ep 27 · 7:07
clinicalThe distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction↗
▶Ep 27 · 8:18
clinicalAfter the pyloromyotomy is completed, the submucosa should bulge into the myotomy site↗
▶Ep 27 · 8:25
clinicalAfter adequate pyloromyotomy, each side of the pylorus should move independently↗
▶Ep 27 · 8:42
clinicalComplications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias↗
▶Ep 27 · 8:52
clinicalThere is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches↗
▶Ep 27 · 9:17
clinicalFor mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall↗
▶Ep 27 · 10:05
clinicalMost infants can be fed immediately after pyloromyotomy↗
▶Ep 27 · 10:13
clinicalEvidence supports ad-lib feeds after pyloromyotomy; once the infant is alert and awake, these infants achieve full feeds sooner with no increase in readmission rates↗
▶Ep 27 · 10:32
clinicalSmall episodes of emesis after pyloromyotomy are almost to be expected as the stomach recovers from days to weeks of progressive dilation↗
▶Ep 27 · 10:44
clinicalOdds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter↗