Pediatrics, Pyloric Stenosis Clinical Presentation

  • Author: Jagvir Singh, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Jun 22, 2010
 

History

  • Classically, the infant with pyloric stenosis has nonbilious vomiting or regurgitation, which may become projectile (in as many as 70% of cases), after which the infant is still hungry.[4]
  • Emesis may be intermittent or occur after each feeding.
  • The emesis may become brown or coffee color due to blood secondary to gastritis or a Mallory-Weiss tear at the gastroesophageal junction.
  • The infant begins to show signs of dehydration and malnutrition, such as poor weight gain, weight loss, marasmus, decreased urinary output, lethargy, and shock.
  • The infant may develop jaundice, which is corrected upon correction of the disease.
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Physical

  • In as many as 60-80% of the infants with infantile hypertrophic pyloric stenosis (IHPS), a firm, nontender, and mobile hard pylorus that is 1-2 cm in diameter, described as an "olive," may be present in the right upper quadrant at the lateral edge of the rectus abdominus muscle. This is best palpated after the infant has vomited and when calm, or when the gastric contents have been removed via nasogastric tube.
  • Clinicians may also observe gastric peristalsis just prior to emesis as the peristaltic waves try to overcome the obstruction.
  • Signs of dehydration include depressed fontanelles, dry mucous membranes, decreased tearing, poor skin turgor, and lethargy.
  • The classic signs of infantile hypertrophic pyloric stenosis are becoming less common. The mean age of presentation is getting significantly younger, and infants are not developing the physical signs or electrolyte abnormalities they were 20 years ago. Additionally, the availability of diagnostic imaging is allowing clinicians to make this diagnosis before other clinical manifestations appear.
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Causes

  • The etiology of infantile hypertrophic pyloric stenosis is unknown and is probably multifactorial.
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Contributor Information and Disclosures
Author

Jagvir Singh, MD  Director, Division of Pediatric Emergency Medicine, Lutheran General Hospital of Park Ridge

Jagvir Singh, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Dara A Kass, MD  Clinical Assistant Instructor, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital

Dara A Kass, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Consultant, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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Lateral view from an upper GI study demonstrates the double-track sign.
 
 
 
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