An infant is suffering from hypertrophic pyloric stenosis is admitted in the pediatric unit. What does the nurse expect to find when assessing the child?

1. A

   Bilious vomiting

2. B

   Olive shaped mass palpated on right quadrant of the abdomen

3. C

   Abdominal distension

4. D

   Abdominal tenderness

Appeared in: NORCET-7 Mains-2024

Explanation

Listen in Hindi

• The key finding in hypertrophic pyloric stenosis (HPS) is the palpation of a firm, movable, olive-shaped mass in the right upper quadrant of the abdomen.
• This mass is the hypertrophied (thickened) pyloric sphincter muscle, which is the pathognomonic or hallmark sign of the condition.
• This finding is most easily elicited when the infant's abdominal muscles are relaxed, such as when they are calm or have just vomited.
• Another classic sign is progressive, projectile, non-bilious vomiting that occurs shortly after feeding.

Why Other Options Were Wrong

• Option A: Vomiting in HPS is non-bilious (not containing bile). The obstruction is at the stomach outlet, proximal to the entry of the bile duct into the duodenum.
• Option C: Generalized abdominal distension is not a feature of HPS. Because food cannot pass into the intestines, the lower abdomen is often flat or even scaphoid (sunken).
• Option D: The abdomen in an infant with HPS is typically non-tender. The condition is a mechanical obstruction, not an inflammatory or infectious process.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Clinical assessment findings of Hypertrophic Pyloric Stenosis (HPS) in an infant to guide bedside assessment, documentation, and the next nursing action.
• Recognizing the classic signs of HPS, especially the olive-shaped mass and non-bilious projectile vomiting, is crucial for early diagnosis and referral for surgical correction (pyloromyotomy).
• Pre-operative nursing care is focused on correcting dehydration and electrolyte imbalances (hypochloremic metabolic alkalosis) with IV fluids to stabilize the infant for surgery.
• What if? If the infant's vomiting were bilious (green-stained), the nurse should consider this a red flag for a different, potentially more urgent surgical emergency like intestinal malrotation with volvulus, which can quickly lead to bowel ischemia and necrosis. This would require immediate surgical consultation.

How to Approach the Question

• First, identify the core subject of the question: the clinical signs of hypertrophic pyloric stenosis (HPS) in an infant.
• Recall the pathophysiology of HPS: the pylorus muscle thickens, blocking the stomach outlet.
• Think through the classic signs this blockage would cause. The most specific physical finding is the thickened muscle itself, which can be felt.
• Evaluate each option based on this understanding. Ask yourself: 'Does this sign fit with an obstruction at the very end of the stomach?'
• Eliminate 'bilious vomiting' because the blockage is before the bile duct. Eliminate 'abdominal distension' because the intestines are empty. Eliminate 'tenderness' because it's not an inflammatory issue.
• Select the option describing the palpable, olive-shaped mass, which is the hallmark physical exam finding for HPS.

Concept Tested & Keywords

• Concept Tested: Clinical assessment findings of Hypertrophic Pyloric Stenosis (HPS) in an infant.
• Stem keywords: infant, hypertrophic pyloric stenosis, pediatric unit, assessing
• Lead-in keywords: What does the nurse expect to find
• Clinical cues: The diagnosis of hypertrophic pyloric stenosis is already given, which directs the focus to its specific signs and symptoms.

Question ID

QJEU9_LGHnwOeThW5kqPcK

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 58-60

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 158-160