Pyloric stenosis: Difference between revisions

Revision as of 23:42, 1 March 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 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

Authors:

@@ Line 2: / Line 2: @@
-* more common in males & 1st born children. d/t pyloric hypertrophy in 1st mos of life (usu 3-6 wks, w/ a range of 1-10 wks)
+* More common in males (5:1) & firstborn children (30%)
-* rare in 1st days of life
+* Symptoms usually begin between 3-6 weeks of age, rarely after 12 weeks
@@ Line 9: / Line 9: @@
-* S/S: vomiting (often projectile), ask if blurp up milk or clears the clothes. infant hungry but vomits soon after eating w/ NEVER any bile, maybe some blood. constipation, olive in RUQ to mid quadrant, occ see peristaltic waves
+* 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
-* AXR w/ lg stomach bubble may suggest gastric obstruction but usu nl
+* Imaging
-* U/S used to look at dm of pylorus, UGI shows "string sign" from narrow pylorus
+* 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
@@ Line 18: / Line 27: @@
-* NGT, IVF (do NOT give LR b/c more alkalotic & infant already vomiting up all its HCl, alkalosis can= apnea in infants!), after initial NS can give D5NS w/ KCl, surgery needed (pyloromyotomy) but can be delayed 24-36 hr to reydrate infant
+* 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
 [[Category:Peds]]