Pyloric stenosis: Difference between revisions
No edit summary |
No edit summary |
||
Line 1: | Line 1: | ||
==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 | |||
# 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== | ==Differential Diagnosis== | ||
#Adrenal crisis | |||
#hyperkalemic acidosis | |||
#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=== | |||
* 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 | ||
==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
- 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
- hyperkalemic acidosis
- 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)
- Normal electrolytes and no e/o dehydration
- NGT
- Surgery
- 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