In which condition is projectile vomiting seen?

RRB Nsg. Superintendent 21 July 2019 (shift 1st)

Child Health Nursing (Pediatrics)

Easy

Appeared in: RRB Nsg. Superintendent 21 July 2019 (shift 1st)

Explanation

Pyloric stenosis is the hypertrophy (thickening) of the pylorus muscle at the outlet of the stomach, causing a blockage.
This obstruction prevents stomach contents from passing into the small intestine.
The stomach muscles contract with great force to try and push contents past the blockage, resulting in the characteristic non-bilious, projectile vomiting.
A key physical finding is a firm, movable, olive-shaped mass that can be palpated in the infant's upper abdomen.

Option A: Duodenal atresia causes bilious (green-stained) vomiting, not the non-bilious vomiting seen in pyloric stenosis. The obstruction is in the duodenum, which is after the point where bile enters the GI tract.
Option B: The classic triad for intussusception is colicky abdominal pain, a palpable sausage-shaped mass, and 'currant jelly' stools. While vomiting occurs, it is typically bilious and not the primary, forceful projectile type.
Option C: Megacolon, or Hirschsprung's disease, is a functional obstruction of the colon. Its hallmark is the failure to pass meconium in the first 24-48 hours of life, followed by abdominal distension and bilious vomiting.

Visual 1: Anatomical Diagram - A cross-section of an infant's stomach showing the thickened pyloric muscle, contrasting it with a normal pylorus. This helps visualize the physical obstruction.
Visual 2: Comparison Chart - A table comparing the key signs of Pyloric Stenosis, Duodenal Atresia, and Intussusception, focusing on the type of vomit (bilious vs. non-bilious), stool characteristics, and associated physical findings.
Visual 3: Illustration - An image depicting the 'olive-shaped mass' being palpated in an infant's abdomen to show the location and technique for this key diagnostic sign.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical manifestations of gastrointestinal obstructions in infants as background academic context rather than a clinical decision trigger.
A nurse's primary role is to differentiate between bilious and non-bilious vomiting. Non-bilious vomiting points to an obstruction before the duodenum (like pyloric stenosis), while bilious vomiting indicates a blockage further down, which is often a more urgent surgical emergency.
Pre-operative management is critical. The nurse must ensure the infant is NPO (nothing by mouth), monitor for signs of dehydration, and administer IV fluids to correct the hypochloremic metabolic alkalosis before the infant can safely undergo surgery (pyloromyotomy).
What if? - If the infant's vomit was bilious (green), the nurse's assessment would shift immediately. Bilious vomiting is a red flag for conditions like intestinal malrotation with volvulus, a surgical emergency that can lead to bowel necrosis if not treated promptly. The priority would be immediate notification of the physician and preparation for urgent diagnostic imaging.

How to Approach the Question

First, identify the key clinical sign presented in the question: 'projectile vomiting'.
Next, recall the classic presentations of common gastrointestinal disorders in infancy.
Associate 'projectile vomiting' that is typically non-bilious with an obstruction at the stomach outlet. This is the defining feature of pyloric stenosis.
Systematically rule out the other options by recalling their distinct features: Duodenal atresia (bilious vomit, 'double-bubble' sign), Intussusception ('currant jelly' stool, colicky pain), and Megacolon (failure to pass meconium, abdominal distension).

Concept Tested & Keywords

Concept Tested: Clinical manifestations of gastrointestinal obstructions in infants
Stem keywords: projectile vomiting
Lead-in keywords: In which condition
Negative lead-in flag: false

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