Pyloric stenosis: The Daily PANCE Blueprint
A 4-week-old infant presents with projectile nonbilious vomiting and weight loss. What physical exam finding strongly suggests pyloric stenosis?
A. Sausage-shaped mass RUQ
B. Currant jelly stool
C. Olive-shaped mass in the epigastrium
D. Diffuse abdominal tenderness
E. Steatorrhea
Answer and topic summary
The answer is C. Olive-shaped mass in the epigastrium
Pyloric stenosis is characterized by hypertrophy of the pyloric sphincter, leading to gastric outlet obstruction. It typically presents in infants around 2-8 weeks of age with progressive, projectile, nonbilious vomiting (as the obstruction is proximal to the ampulla of Vater), dehydration, and failure to thrive. A hallmark physical exam finding is a palpable, firm, mobile, olive-shaped mass in the epigastrium or right upper quadrant, best felt during or just after feeding when the infant is relaxed. Peristaltic waves may also be visible across the upper abdomen.
Incorrect Answer Explanations:
- A. A sausage-shaped mass in the right upper quadrant or mid-abdomen is more characteristic of intussusception, which typically presents with colicky abdominal pain and currant jelly stools.
- B. Currant jelly stool (stool mixed with blood and mucus) is a classic sign of intussusception.
- D. Diffuse abdominal tenderness is a non-specific finding and could suggest various conditions like gastroenteritis, peritonitis, or necrotizing enterocolitis, but is not the specific palpable finding for pyloric stenosis.
- E. Steatorrhea (fatty, foul-smelling stools) is indicative of malabsorption, often seen in conditions like cystic fibrosis or celiac disease, not pyloric stenosis.
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Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ ⇒
