Characteristic symptom of congenital hypertrophic pyloric stenosis is:

IGNOU PB Bsc Entrance-2023

Child Health Nursing (Pediatrics)

Easy

Appeared in: IGNOU PB Bsc Entrance-2023

Explanation

Congenital Hypertrophic Pyloric Stenosis (CHPS) involves the thickening (hypertrophy) of the pyloric sphincter, which is the muscle at the outlet of the stomach.
This thickening causes a gastric outlet obstruction, preventing stomach contents from passing into the small intestine.
The classic symptom is projectile vomiting because the stomach contracts forcefully against the obstruction.
The vomit is non-bilious (not containing bile) because the obstruction occurs proximal to the ampulla of Vater, where bile enters the duodenum.

Option B: Dysentery is characterized by inflammation of the intestine, leading to bloody diarrhea. It is typically caused by an infection (like Shigella) and is unrelated to the structural, non-inflammatory gastric obstruction of pyloric stenosis.
Option C: Fever indicates an infectious or inflammatory process. Pyloric stenosis is a mechanical/structural problem, not an infection, so fever is not a primary symptom.
Option D: While infants with pyloric stenosis are often irritable and fussy due to constant hunger, distinct epigastric pain is not the hallmark symptom. The primary driver of their distress is the inability to retain food, not localized pain in the way an older child or adult would experience it.

Clinical Relevance

Nursing practice connection: Knowing Clinical presentation of Congenital Hypertrophic Pyloric Stenosis (CHPS) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing responsibility is to assess for signs of dehydration in an infant with suspected pyloric stenosis. This includes checking for sunken fontanelles, decreased skin turgor, reduced urine output (fewer wet diapers), and lethargy. Prompt recognition is vital.
Nurses play a crucial role in preparing the infant and family for surgery (pyloromyotomy). This involves ensuring the infant's fluid and electrolyte imbalances (especially hypochloremic metabolic alkalosis) are corrected pre-operatively to ensure safety during anesthesia.
What if? If the infant's vomit was bilious (green-stained), it would indicate an obstruction located after the entry of the bile duct into the duodenum. This is a surgical emergency and points towards different diagnoses like malrotation with volvulus or duodenal atresia, requiring a more urgent and different diagnostic pathway.

How to Approach the Question

First, identify the key condition in the question: 'congenital hypertrophic pyloric stenosis'.
Recall the pathophysiology of this condition: 'hypertrophic' means enlarged muscle, and 'pyloric' refers to the stomach outlet. This creates a blockage.
Think about the consequence of a blockage at the stomach outlet. Food (milk) cannot pass into the intestine, so it must come back up as vomit.
Consider the nature of the blockage. The stomach will contract powerfully to try and overcome it, making the vomiting 'projectile'.
Determine the location of the blockage relative to other structures. The pylorus is before the duodenum where bile enters. Therefore, the vomit will be 'non-bilious' (no bile).
Combine these deductions: the characteristic symptom is projectile, non-bilious vomiting. Compare this with the given options to find the correct answer.

Concept Tested & Keywords

Concept Tested: Clinical presentation of Congenital Hypertrophic Pyloric Stenosis (CHPS)
Stem keywords: congenital hypertrophic pyloric stenosis, characteristic symptom
Lead-in keywords: is
Negative lead-in flag: false

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

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 295-297