Infantile hypertrophic Pyloric Stenosis
Gastroenterology
Presentation
non-bilious projectile vomiting immediately after feeds, and hungry again
usually 3-6 weeks, rare after 12w
5:1 M:F, polygenetic inheritance (ie son of affected mother most likely to get it)
More common in prems, first borns, smoking mums, bottle fed, with macrolide antibiotics
Ex
Palpable olive at lateral edge of rectus abdominus in RUQ (less likely now days as picking early before large mass and prior to fat loss
Ix
Hydrochloric acid loss leads to hypochloraemic hypokalaemic metabolic alkalosis
K loss in vomit and urine > hypokalaemia if late presentation ie vomiting for >3weeks
Urine electrolytes: low Cl (to counter loss in vomit) low Na through RAA to maintain BP, high pH initial to drop HCO3 however with K loss eventually high to maintain K above critical
DDx
Vomiting
Counselling
Female: son has 1:5 risk, daughter 1:14
Male: sone has 1:20, daughter 1:40
Presentation
non-bilious projectile vomiting immediately after feeds, and hungry again
usually 3-6 weeks, rare after 12w
5:1 M:F, polygenetic inheritance (ie son of affected mother most likely to get it)
More common in prems, first borns, smoking mums, bottle fed, with macrolide antibiotics
Ex
Palpable olive at lateral edge of rectus abdominus in RUQ (less likely now days as picking early before large mass and prior to fat loss
Ix
Hydrochloric acid loss leads to hypochloraemic hypokalaemic metabolic alkalosis
K loss in vomit and urine > hypokalaemia if late presentation ie vomiting for >3weeks
Urine electrolytes: low Cl (to counter loss in vomit) low Na through RAA to maintain BP, high pH initial to drop HCO3 however with K loss eventually high to maintain K above critical
DDx
Vomiting
Counselling
Female: son has 1:5 risk, daughter 1:14
Male: sone has 1:20, daughter 1:40