Pyloric stenosis

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Background

  • More common in males (5:1) & firstborn children (30%)
  • Symptoms usually begin between 3-6 weeks of age, rarely after 12 weeks


Diagnosis

  • 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
  • Labs might show a low K, Low Cl, & hypo-Cl alkolosis
  • Imaging
  • Abdominal xray: May show large stomach bubble
  • U/S: ~ 95% Sn/Sp


Differential Diagnosis

  • Adrenal crisis may mimic pyloric stenosis
  • However, adrenal crisis: hyperkalemic acidosis; pyloric stenosis: hypokalemic alkalosis


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)
  • Ensure that kidneys are functional prior to giving potassium
  • Do not give LR
  • May lead to worsening alkalosis --> apnea in infants
  • NGT
  • Surgery
  • Can be delayed 24-36 hr to rehydrate infant


Source: UpToDate

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