Pyloric stenosis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
# Immediate post-prandial, non-bilious, often projectile vomiting, but desires to feed ("hungry vomiter") | #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 | #Palpable mass in in RUQ to epigastric region, occassionally may see peristaltic waves | ||
# Labs | #Labs may show hypokalemia, hypochloremia alkalosis | ||
# Imaging | #Imaging | ||
## Abdominal xray: May show large stomach bubble | ##Abdominal xray: May show large stomach bubble | ||
## U/S: ~ 95% Sn/Sp | ##U/S: ~ 95% Sn/Sp | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 27: | Line 27: | ||
===Precautions=== | ===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 | **May lead to worsening alkalosis > apnea in infants | ||
==Source== | ==Source== | ||
UpToDate | UpToDate | ||
Tintinalli | |||
[[Category:Peds]] | [[Category:Peds]] | ||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 22:13, 13 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 may show hypokalemia, hypochloremia alkalosis
- 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
Tintinalli