Question 5
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30 day old boy is brought by his mother due to increased vomiting that is projectile in nature since 6 hours ago. The vomitus is not green and only contains clear liquids. The mother is highly apprehensive about the health of the baby and says the baby is just crying and not feeding. On examination the child looks dehydrated, and has tenderness all over the abdomen. On his abdomen the physician notes visible waves. The radiograph taken is shown above. The patient is evaluated and is admitted in the PICU for further management. What is the most likely diagnosis?
A) Duodenal Atresia
B) Hypetrophic pylorus
B) Hypetrophic pylorus
C) Malrotation
D) Meckels Diverticulum
E) Esophageal atresia
F) Intussusception
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2 comments:
Answer: B) Hypertrophic Pylorus
Points to note:
Hypertrophic pyloric stenosis presents commonly at about "4-6 weeks after birth". The case will present with "non-bilious projectile vomiting". Abdomen will show "visible gastric peristalsis", and a "olive shaped mass" may be palpable. Imaging would show "string sign", and pyloric obstruction.
Admit the patient, Hydrate and do a USG.
Other options:
Duodenal atresia presents with bilious vomitus on first day of birth.
Malrotation of GUT: again with bilious vomitus, bloody stool with mucus and abdominal distension.
Meckels diverticulum: Rule of 2's
Esophageal atresia: Presents at birth as respiratory distress.
That is easy. Hypertrophic Pyloric Stenosis.
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