Q 1:
A5-week-old bottle-fed boy presents with persistent and worsening projectile vomiting, poor weight gain, and hypochloremic metabolic alkalosis. Of the following diagnostic modalities, which would most likely reveal the diagnosis?
(A) ultrasound of abdomen
(B) barium enema
(C) evaluation of stool for ova and parasites
(D) testing well water for presence of nitrites
(E) serum thyroxine
Answer:
(A)
The case presented is classic of pyloric stenosis. This results from hypertrophy and hyperplasia of smooth muscle in the stomach, causing a narrowed, even, obstructed outlet.
Persistent projectile vomiting causes ongoing losses of calories and electrolytes, resulting in growth failure and hypochloremic metabolic alkalosis. Hyponatremia and hypokalemia may also be associated. Often, the diagnosis can be made by physical examination alone. However, if an olive-shaped mass is not palpated, an
abdominal ultrasound may confirm the diagnosis.
Answer:
(A)
The case presented is classic of pyloric stenosis. This results from hypertrophy and hyperplasia of smooth muscle in the stomach, causing a narrowed, even, obstructed outlet.
Persistent projectile vomiting causes ongoing losses of calories and electrolytes, resulting in growth failure and hypochloremic metabolic alkalosis. Hyponatremia and hypokalemia may also be associated. Often, the diagnosis can be made by physical examination alone. However, if an olive-shaped mass is not palpated, an
abdominal ultrasound may confirm the diagnosis.
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