Pyloric stenosis: Difference between revisions
m (Rossdonaldson1 moved page Pyloric Stenosis to Pyloric stenosis) |
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Revision as of 08:18, 1 August 2015
Background
- More common in males (5:1) & firstborn children (30%)
- Symptoms usually begin between 3-6 weeks of age, rarely after 12 weeks
Clinical Features
- Immediate post-prandial, non-bilious, often projectile vomiting, but desires to feed ("hungry vomiter")
- Palpable mass in in RUQ to epigastric region, occassionally may see peristaltic waves
Differential Diagnosis
Pediatric Abdominal Pain
0–3 Months Old
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
Diagnosis
- Labs may show hypokalemia, hypochloremia alkalosis
- Imaging
- Abdominal xray: May show large stomach bubble
- U/S: ~ 95% Sn/Sp
- normal measurements- canal length <12mm; wall width < 3mm
Treatment
- IVF
- Normal electrolytes and no e/o dehydration
- 5% dextrose w/ 0.25% NaCl and 2 meq KCl per 100 mL
- Moderate or severe dehydration
- Higher NaCl concentrations (0.5% to normal saline) and higher rates of administration (1.5 to 2 times maintenance)
- Normal electrolytes and no e/o dehydration
- NGT
- Surgery
- Can be delayed 24-36 hr to rehydrate infant and correct electrolytes
Precautions
- Ensure that kidneys are functional prior to giving potassium
- Do not give LR
- May lead to worsening alkalosis > apnea in infants