Pyloric stenosis: Difference between revisions
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* 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== | ||
*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 | ||
==Differential Diagnosis== | |||
*Adrenal crisis | |||
*hyperkalemic acidosis | |||
*hypokalemic alkalosis | |||
==Diagnosis== | |||
*Labs may show hypokalemia, hypochloremia alkalosis | *Labs may show hypokalemia, hypochloremia alkalosis | ||
*Imaging | *Imaging | ||
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**U/S: ~ 95% Sn/Sp | **U/S: ~ 95% Sn/Sp | ||
***normal measurements- canal length <12mm; wall width < 3mm | ***normal measurements- canal length <12mm; wall width < 3mm | ||
==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 | ||
Revision as of 08:14, 1 August 2015
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
- Adrenal crisis
- hyperkalemic acidosis
- hypokalemic alkalosis
Diagnosis
- Labs may show hypokalemia, hypochloremia alkalosis
- Imaging
- Abdominal xray: May show large stomach bubble
- U/S: ~ 95% Sn/Sp
- normal measurements- canal length <12mm; wall width < 3mm
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
Precautions
- Ensure that kidneys are functional prior to giving potassium
- Do not give LR
- May lead to worsening alkalosis > apnea in infants