NORCET 2 -2021 (Shift…: Non bilious vomiting is seen in?

NORCET 2 -2021 (Shift-2)

Child Health Nursing (Pediatrics)

Medium

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

Pyloric stenosis is the narrowing (stenosis) of the pylorus, the opening from the stomach into the small intestine.
This condition creates a gastric outlet obstruction, preventing stomach contents from moving forward.
Because the blockage is located before the ampulla of Vater (where bile enters the duodenum), the vomited material does not contain bile, making it non-bilious.
The vomiting is classically described as forceful and projectile, occurring after feeds in infants typically between 3-5 weeks of age.

Option B: Vomiting in pancreatitis is typically bilious. The inflammation can cause a functional obstruction (ileus) of the nearby duodenum, which is distal to where bile enters the GI tract.
Option C: Vomiting in appendicitis is a common but later symptom that usually follows the onset of abdominal pain. It is typically bilious due to reflex ileus or peritonitis.
Option D: The acronym TOF is ambiguous. If it means Tetralogy of Fallot, it is a congenital heart defect where vomiting is not a primary symptom. If it means Tracheoesophageal Fistula, it presents at birth with choking, coughing, and non-bilious regurgitation with the first feed, not the characteristic projectile vomiting of pyloric stenosis that develops weeks later.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of non-bilious vomiting in pediatric patients as background academic context rather than a clinical decision trigger.
A key nursing assessment is to differentiate non-bilious from bilious vomiting. Bilious vomiting in an infant is considered a surgical emergency until proven otherwise, as it may indicate malrotation with volvulus.
Nurses must closely monitor infants with persistent vomiting for signs of dehydration (e.g., sunken fontanelle, dry mucous membranes, decreased urine output) and the classic electrolyte imbalance of hypochloremic metabolic alkalosis.
A classic physical finding in pyloric stenosis is a firm, mobile, olive-shaped mass in the epigastrium, which a nurse may palpate during assessment.

How to Approach the Question

First, identify and define the key term in the question: 'non-bilious vomiting'. This means the vomitus is free of bile.
Recall the basic anatomy of the upper gastrointestinal tract. Bile enters the second part of the duodenum at the ampulla of Vater.
Reason that for vomiting to be non-bilious, the obstruction must be located proximal (before) the ampulla of Vater. This points to a gastric outlet obstruction.
Evaluate each option based on this anatomical principle.
Pyloric stenosis is a classic gastric outlet obstruction. Pancreatitis and appendicitis cause inflammation and ileus distal to the stomach. TOF (Tracheoesophageal fistula) involves the esophagus, and while regurgitation is non-bilious, it's not the same as the projectile vomiting described in pyloric stenosis.
Conclude that pyloric stenosis is the most fitting diagnosis for non-bilious vomiting.

Concept Tested & Keywords

QI27dAMs79TxJ3x8npWI40

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

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

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1062-1064