Male1: There is this classical thing taught in medical school, first one male, about a month to six weeks old, starts vomiting and there is thing called pyloric stenosis. You do not see it as much as we used to I think, but we do see it time to time. First of all, what is pyloric stenosis.
Male2: Well, I do not who we is in your sentence. I last operated on pyloric stenosis 48 hours ago and it is more common in boys than girls. It is probably more common in the first born, although that sounds very biblical to me, it is a condition that occurs second, third, fourth week of life up to about six to eight weeks of life--
Male1: Do they all need surgery?
Male2: Well, the outlet of the stomach gets really think and they have trouble getting their milk down. The mother gets so upset because they are forcefully vomiting getting dehydrated, pediatrician gets quite concerned because the baby is not gaining weight. In the old days, none of them got surgery. Many of them got better and some died because they did not get their sodiums and their potassiums and their nutrition. Today, once you make the diagnosis, a very simple sonogram, a good pediatric imaging doctor, radiology, make the diagnosis. Get the sodium corrected, get the baby enough fluid that they are making pee, get them ready for the operation. A good pediatric anesthesiologist who knows how to take a small baby with a blocked stomach, get them to sleep safely, a surgeon can with minimally invasive techniques, little tiny openings or a scar about this big, either one, just open up the muscle. Do not remove anything. Do not saw anything, just open up the muscle. The outcome should be a 100% long term satisfied. Today, we would not wait to see which one of these babies will snap out of this on their own because it could take a long time. It did not always work and then in the right hands, the operation ought to be universally successful. Maybe ends up with the tiniest scars and the mother and father have a memory and it is otherwise not functionally, physiologically a problem for the child.
Male1: The vomiting is somewhat classical?
Male2: Forceful vomiting never green. Anytime a baby vomits green material by the way, that is an emergency, but it is not pyloric stenosis. It is an emergency because it means that things are washing up from the intestine across the pylorus into the stomach and we are worried that the bowel could be twisted or lost its blood supply. Pyloric stenosis, more often boys than girls, two to eight weeks of life, non-green, not bile, vomiting forcefully, not gaining weight is very suggestive that it needs a sonogram.
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