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  


==Diagnosis==
==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
* Immediate post-prandial, non-bilious, often projectile vomiting, but desires to feed ("hungry vomiter")
# Labs might show a low K, Low Cl, & hypo-Cl alkolosis
* Palpable mass in in RUQ to epigastric region, occassionally may see peristaltic waves
# Imaging
* Labs might show a low K, Low Cl, & hypo-Cl alkolosis
## Abdominal xray: May show large stomach bubble
* Imaging
## U/S: ~ 95% Sn/Sp
* Abdominal xray: May show large stomach bubble
* U/S: ~ 95% Sn/Sp
   
   
==Differential Diagnosis==
==Differential Diagnosis==
 
#Adrenal crisis
 
#hyperkalemic acidosis
* Adrenal crisis may mimic pyloric stenosis
#hypokalemic alkalosis  
* However, adrenal crisis: hyperkalemic acidosis; pyloric stenosis: hypokalemic alkalosis  


==Treatment==
==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)
# NGT
# Surgery
## Can be delayed 24-36 hr to rehydrate infant


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


==Source==
UpToDate


[[Category:Peds]]
[[Category:Peds]]
[[Category:GI]]

Revision as of 23:33, 7 June 2011

Background

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

Diagnosis

  1. Immediate post-prandial, non-bilious, often projectile vomiting, but desires to feed ("hungry vomiter")
  2. Palpable mass in in RUQ to epigastric region, occassionally may see peristaltic waves
  3. Labs might show a low K, Low Cl, & hypo-Cl alkolosis
  4. Imaging
    1. Abdominal xray: May show large stomach bubble
    2. U/S: ~ 95% Sn/Sp

Differential Diagnosis

  1. Adrenal crisis
  2. hyperkalemic acidosis
  3. hypokalemic alkalosis

Treatment

  1. IVF
    1. Normal electrolytes and no e/o dehydration
      1. 5% dextrose w/ 0.25% NaCl and 2 meq KCl per 100 mL
    2. Moderate or severe dehydration
      1. Higher NaCl concentrations (0.5% to normal saline) and higher rates of administration (1.5 to 2 times maintenance)
  2. NGT
  3. Surgery
    1. Can be delayed 24-36 hr to rehydrate infant

Precautions

  • Ensure that kidneys are functional prior to giving potassium
  • Do not give LR
  • May lead to worsening alkalosis --> apnea in infants

Source

UpToDate