The abdominal mass in congenital hypertrophic pyloric stenosis in a new born child can be best palpated:
Ans. a. In the midepigastric areaRef: Nelson Text book of Pediatrics 20th Ed; Page No-1797CLINICAL INCIDENCEHypertrophic pyloric stenosis occurs in 1-3 per 1,000 infants in the United States.It is more commonly seen in whites of northern European ancestry, less common in blacks, and rarely seen in Asians. Males (especially firstborns) are more commonly affected approximately 4-6 times as often as females.The father who had pyloric stenosis is at higher risk to offsprings for pyloric stenosis comparing to mother.Pyloric stenosis more commonly seen male with an incidence rate of 20% and 10% of the female descendants of a mother who had pyloric stenosis.ETIOLOGYPyloric stenosis is usually not present at birth. It is unusual in stillbirths and probably develops after birth and is more concordant in monozygotic than dizygotic twins.Pyloric stenosis commonly associated with eosinophilic gastroenteritis, Zellweger syndrome, Apert syndrome, Smith-Lemli-Opitz syndrome, trisomy 18, and Cornelia de Lange syndrome.CLINICAL MANIFESTATIONSInitial symptom of pyloric stenosis is nonbilious vomiting. The vomiting may or may not be projectile initially but is usually progressive, occurring immediately after a feeding.The most common clinical symptoms of pyloric stenosis is hyperbilirubinemia, it is also known as icteropyloric syndrome.Unconjugated hyperbilirubinemia is more common seen compare to conjugated.DIAGNOSISPalpating the pyloric mass is the most diagnostic factor.The mass is movable, firm, olive shaped, approximately 2 cm in length, hard, and it is best palpated from the left side, and located above and to the right of the umbilicus in the midepigastrium beneath the livers edge.After an episode of vomiting the easiest palpated is olive shaped mass.Gastric peristaltic wave may be visible after feeding, that progress across the abdomen.Gastric peristaltic wave in an infant with pyloric stenosisTwo imaging studies are most commonly used to establish the diagnosis. For majority of cases ultrasound examination confirms the diagnosis. Criteria for diagnosis are an overall pyloric length 15-19 mm, pyloric diameter of 10-14 mm and pyloric thickness 3-4 mm.Ultrasonography is the most sensitivity (approximately 95%) test.An elongated pyloric channel (string sign), parallel streaks of barium seen in the narrowed channel, producing a "double tract sign" and a bulge of the pyloric muscle into the antrum (shoulder sign) are seen in contrast studies.Double tract sign
In the midepigastric area
In the right hypochondriac quadrant
In the umbilical area
During feeding
Gastro Intestinal System