A 6 year old boy presenting with palpable abdominal mass in the epigastrium. The clinical diagnosis is (There is no bile in vomitus).
Ans. is 'c' Pyloric stenosis Clinical features which suggests the diagnosis of Pyloric stenosisVomitting without bileMass palpable in epigastriumOther options can be easily ruled outCholedochal cystIt can also present as mass in abdomen but the mass is usually present in right upper Quadrant.Jaundice will be a prominent symptom andUsually there is no vomitingDuodenal Atresia #Mass (Peristaltic wave) is usually present in the left upper quadrant and the vomiting is bile stained*.Child vomits from birth*Esophageal atresia -There is excessive drooling, saliva is frothy and there is choking and cyanosis with 1st feed.No mass in abdomen, no vomiting.So the boy is having pyloric stenosis. The only problem is age of boy i.e. 6 yrs. The hypertrophic pyloric stenosis which we know of, makes its clinical presentation in early infancy (3rd to 6th weeks of life*)But the problem in solved once you know that there is a similar disease in adults - Hypertrophic pyloric stenosis of adults. (Bailey & Love, 22/e, p 675).
Duodenal Atresia
Choledochal cyst
Pyloric stenosis
Oesophageal Atresia
Stomach and Intestines