A baby 4 weeks old presents with non-bilious vomiting and abdominal distension, on radiological examination this is the presentation of the baby, among the given options, which is the most essential feature in reaching the diagnosis of this condition?
Ans. D Palpation of the hypertrophic pylorus Diagnosis based on the figure is Hypertrophic pyloric stenosis, observe the bilateral thickening of the stomach lumen which is seen in pyloric-antrum, this condition is due to hypertrophy of the circular muscles. This bilateral thickening is referred to as double track appearance. * Occurs in 3 per 1000 babies and four times as many boys as girls. * There is hypertrophy of pyloric antrum being maximum in the circular fibers of the pylorus. * Size of the lump is proportional to the duration of symptoms. * Firstborn males are most commonly affected at 4 weeks of life (range 3-6 weeks) Symptoms - Vomiting of milk without bile staining - Visible Peristalsis from left to right. - Presence of Lump is essential. - Constipation with rabbit-like stool. - Loss of weight. * There is hypochloremic, hypokalemic, hyponatremic metabolic alkalosis * Ultrasound is the investigation of choice, however, to be diagnostic barium meal show elongation of pylorus canal >17 mm with muscle thickness > 4 mm. * Ramstedt's operation (Pyloromyotomy) is the surgery of choice. * Postoperative pyrexia is a common complication. The child should be feeding normally in 48 hours. If the mucosa was accidentally opened at operation, do not feed the child orally for 48 hours. Hypertrophic pyloric stenosis in adults is treated by or gastrojejunostomy or pyloroplasty. Image source-
Visible peristalsis
Project vomiting
Loss of weight and dehydration
Palpation of the hypertrophic pylorus