Make the diagnosis of a 26 day old Infant presenting with recurrent nonbilious vomiting with costipation and loss of wt:
Ans. is 'd' ie Pyloric stenosis.This is a typical picture of pyloric stenosisInfant presenting in 4 th weekNon-bilious vomitting.With constipation and wt. loss.Lets see other options.Esophageal atresiaInfant presents soon after birth with complaints of regurgitation of milk, saliva pours almost continuously from its mouth. Attempt to feed are met with 'Spitting up' or frank vomitting.Persistence in feeding may produce aspiration, choking and respiratory distress.Diagnosis can be confirmed by passing a rubber catheter into the esophagus through the mouth which will encounter an obstruction.- Thus point (a) helps in ruling out oesophageal atresia.Choledochal cystPresentation is not so early in infancy. Though its a congenital anomaly only 1/2 the cases present before 20yrs. of age and only 1/3 present in the 1st decade of life.Classical triad of symptoms- i) Obstructive jaundice* ii) Upper abdominal pain*Hi) Fever*(c) A palpable epigastric mass may be discovered.Points (a) and (b) definitely go against choledochal cyst in this infant.Ileal atresiaVomitting will be biliousInfant presents in the 1st week of life.
Oesophageal atresia
Choledochal cyst
ileal atresia
Pyloric stenosis
Benign Gastric Disease