Palpable pyloric tumour and projectile vomiting is found in

Appeared in: UPPSC 2022

Explanation

Pyloric stenosis is characterized by the hypertrophy (thickening) of the pyloric sphincter muscle, which creates a gastric outlet obstruction.
This obstruction prevents stomach contents from passing into the small intestine, leading to forceful, non-bilious projectile vomiting, typically occurring 3-6 weeks after birth.
The thickened muscle can often be palpated as a firm, mobile, olive-shaped mass (referred to as a 'pyloric tumour') in the infant's upper abdomen.
The infant is characteristically hungry immediately after vomiting episodes due to the obstruction.

Option B: Megacolon (Hirschsprung's disease) is an obstruction of the large intestine. Its primary symptoms are failure to pass meconium at birth, severe constipation, and abdominal distension, not projectile vomiting or a pyloric mass.
Option C: Diarrhoea is characterized by frequent, loose, watery stools, which is a sign of increased intestinal motility. This is the opposite of the gastric outlet obstruction seen in pyloric stenosis.
Option D: Omphalocele is a congenital abdominal wall defect visible at birth, where abdominal organs protrude through the umbilical ring, enclosed in a sac. It is a structural anomaly unrelated to pyloric muscle function.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical presentation of hypertrophic pyloric stenosis as background academic context rather than a clinical decision trigger.
Early recognition of pyloric stenosis is critical for nurses to prevent complications like severe dehydration, malnutrition, and hypochloremic metabolic alkalosis.
A key nursing assessment is to observe for visible peristaltic waves moving from left to right across the infant's abdomen before vomiting, which is another classic sign.
Pre-operative nursing care focuses on correcting fluid and electrolyte imbalances with IV fluids and keeping the infant NPO (nothing by mouth).

How to Approach the Question

First, analyze the keywords in the question stem: 'Palpable pyloric tumour' and 'projectile vomiting'.
Recognize that this combination of a specific physical finding (palpable mass) and a characteristic symptom (projectile vomiting) points to a classic pediatric diagnosis.
Systematically evaluate each option against these two key findings.
Pyloric stenosis is defined by these exact symptoms, making it the strongest candidate.
Eliminate 'Megacolon' as it presents with constipation and distension.
Eliminate 'Diarrhoea' as it is the opposite of an obstruction.

Concept Tested & Keywords

Qay7IylbjJBIrtcj-pfSmK

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

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 756-758

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