Pyloric stenosis: Difference between revisions
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==Background== | ==Background== | ||
* More common in males (5:1) & firstborn children (30%) | *More common in males (5:1) & firstborn children (30%) | ||
* Symptoms usually begin between 3-6 weeks of age, rarely after 12 weeks | *Symptoms usually begin between 3-6 weeks of age, rarely after 12 weeks | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 18: | Line 18: | ||
==Treatment== | ==Treatment== | ||
* [[IVF]] | *[[IVF]] | ||
** Normal electrolytes and no e/o dehydration | **Normal electrolytes and no e/o dehydration | ||
*** 5% dextrose w/ 0.25% NaCl and 2 meq KCl per 100 mL | ***5% dextrose w/ 0.25% NaCl and 2 meq KCl per 100 mL | ||
** Moderate or severe dehydration | **Moderate or severe dehydration | ||
*** Higher NaCl concentrations (0.5% to normal saline) and higher rates of administration (1.5 to 2 times maintenance) | ***Higher NaCl concentrations (0.5% to normal saline) and higher rates of administration (1.5 to 2 times maintenance) | ||
* NGT | *NGT | ||
* Surgery | *Surgery | ||
** Can be delayed 24-36 hr to rehydrate infant and correct electrolytes | **Can be delayed 24-36 hr to rehydrate infant and correct electrolytes | ||
** Ensure correction of bicarbonate level, as it may be a hypoventilation risk | **Ensure correction of bicarbonate level, as it may be a hypoventilation risk | ||
===Precautions=== | ===Precautions=== | ||
Revision as of 13:57, 4 July 2016
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 metabolic alkalosis
- Imaging
- Abdominal xray: may show large stomach bubble
- Upper GI: string sign (narrowed pyloric sphincter)
- U/S: thickened (>3 mm) and elongated (>15 mm) pylorus ~ 95% Sn/Sp[1]
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
- Ensure correction of bicarbonate level, as it may be a hypoventilation risk
Precautions
- Ensure that kidneys are functional prior to giving potassium
- Do not give LR
- May lead to worsening alkalosis > apnea in infants
See Also
References
- ↑ Rohrschneider WK, Mittnacht H, Darge K, Tröger J. Pyloric muscle in asymptomatic infants: sonographic evaluation and discrimination from idiopathic hypertrophic pyloric stenosis. Pediatr Radiol. 1998 Jun;28(6):429-34.