Pyloric Stenosis

Definition
Hypertrophy of muscle layers at pyloric sphincterM:F 4:1 (especially first born males); presents at 2-4weeks; positive FHx

Differential diagnosis

  • GERD
  • Gastroenteritis
  • Pyloric atresia
  • Antral web

Clinical features

  • Palpable mass (olive sign – right margin of rectus)
  • Visible peristalsis (from LUQ to epigastrium)
  • Projectile non-bilious vomiting after feeds
  • Infant will be hungry and attempt to re-feed
  • Constipation, FTT, wasting
  • Dehydration (may lead to jaundice)

Investigations

  • CBCD, lytes, Cr, BUN, glucose, ABG
    • Hypochloremic hypokalemic metabolic alkalosis

Imaging

  • Abdominal ultrasound – pyloric muscle thickness >4mm, length >16mm
  • X-ray (barium) – string sign

Surgical treatment – pyloromyotomy

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