Paediatrics Q8

Pyloric Stenosis

Presentation

1. Age: Typically appears between 3-8 weeks of age.

2. Symptoms: Projectile, non-bilious vomiting is the hallmark symptom. Constipation is also common due to reduced fluid intake.

3. Late Signs: If not treated, the condition can lead to dehydration, malnutrition, and jaundice.

4. Physical Findings: An olive-sized mass may be palpable in the epigastric region, usually on the right side. Visible peristalsis may also be noted, moving from left to right in the upper abdomen.

5. Behavioural Sign: Despite recurrent vomiting, the infant often seems hungry.

Diagnosis

. Initial Step: The immediate concern is assessing serum potassium levels. Hypokalaemia may occur due to frequent vomiting and needs urgent correction.

. Diagnostic Test: An abdominal ultrasound can confirm the diagnosis by showing a hypertrophic pyloric muscle and a “target sign” indicative of the condition.

Treatment

i. Initial Management: The first line of treatment involves correcting dehydration and electrolyte imbalances, particularly metabolic alkalosis. This is usually done with intravenous fluids.

ii. Surgical Consult: Once the child is stabilized, a referral to a pediatric surgeon is necessary for definitive treatment, which usually involves pyloromyotomy and the insertion of a nasogastric (NG) tube.

 

Further Reading: Pyloric Stenosis

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