Flashcards in WISEMD Pediatric Pyloric Stenosis Deck (14)
Is bilious emesis considered a surgical emergency in infants until proven otherwise? Why?
2) Bilious emesis suggests the possibility of midgut volvulus, which is fatal is not operated on immediately
What are causes of non-bilious emesis in infants?
2) Milk allergy
3) Formula intolerance
4) Pyloric stenosis
What are causes of bilious emesis in infants?
3) Incarcerated hernia
What is the age of presentation of pyloric stenosis?
2 weeks - 2 months
What is the gender, race, and child order number most related to pyloric stenosis?
Male, caucasian, first-child
How should one characterize the emesis that arises from pyloric stenosis?
Increasingly frequent and forceful emesis
What are signs of dehydration in an infant with pyloric stenosis that one can obtain from a history?
1) Decreased frequency of wet diapers
What are signs of dehydration in an infant with pyloric stenosis that one can obtain from a physical exam?
1) Sunken fontanelles
2) Dry mucous membranes
3) Decreased capillary refill
What is the PPV of a palpable mass in the abdomen for pyloric stenosis?
99% PPV, but it can be difficult to palpate
What is the progression of electrolyte disturbance in pyloric stenosis and in continued emetic patients?
1) Emesis causes chloride, potassium, and volume loss
2) Hypovolemia and metabolic alkalosis
3) Kidneys retain sodium to correct hypovolemia
4) Excretion of hydrogen in Na-H exchange transport
5) Exacerbation of metabolic alkalosis (paradoxic aciduria)
What is the gold standard technique for diagnosing pyloric stenosis?
Even if you have confirmed the diagnosis of pyloric stenosis, if there is any sign of volvulus or malrotation of the midgut what study should be done to rule out the additional diagnosis?
What are the two steps in treatment of the patient with pyloric stenosis?
1) Resuscitation by administering IV fluids