Projectile vomiting is a characteristic of which of the following conditions?

TMC Staff Nurse - 2019

Child Health Nursing (Pediatrics)

Easy

Appeared in: TMC Staff Nurse - 2019

Explanation

Projectile vomiting is the classic and most prominent symptom of hypertrophic pyloric stenosis (HPS).
HPS involves the thickening of the pyloric sphincter, creating a gastric outlet obstruction.
The stomach muscles contract forcefully to try and push food through the narrowed opening, resulting in the characteristic projectile nature of the emesis.
The vomit is typically non-bilious (not containing bile) because the obstruction is located before the point where bile enters the small intestine.
Other key signs include a palpable 'olive-like' mass in the abdomen, visible peristaltic waves, and persistent hunger after vomiting.

Option B: While an incarcerated or strangulated hernia can cause bowel obstruction and vomiting, the vomiting is not typically projectile. The primary signs of a hernia are a bulge or swelling.
Option C: Imperforate anus is a congenital defect where the anus is absent or improperly located. The primary sign is the failure to pass meconium in the first 24-48 hours of life, along with abdominal distension. Vomiting is a later sign of obstruction and is usually bilious.
Option D: Appendicitis is rare in infants. In older children and adults, the classic presentation is periumbilical pain that migrates to the right lower quadrant, followed by nausea, vomiting, and fever. The vomiting is not characteristically projectile.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of pediatric gastrointestinal disorders as background academic context rather than a clinical decision trigger.
Early recognition of projectile vomiting in an infant is critical for prompt diagnosis of pyloric stenosis to prevent severe dehydration, electrolyte imbalance (hypochloremic metabolic alkalosis), and malnutrition.
Nursing care focuses on pre-operative stabilization, including strict NPO status, IV fluid resuscitation to correct dehydration and alkalosis, and accurate monitoring of intake and output.
Post-operatively, nurses manage a gradual re-introduction of feedings, monitor for continued vomiting (which can occur due to edema), and provide incision care.

How to Approach the Question

First, identify the key clinical sign presented in the question: 'projectile vomiting'.
Note the accompanying image, which visually reinforces the concept of forceful vomiting in an infant.
Systematically review the pathophysiology of each option to determine which one causes this specific type of vomiting.
Recall that pyloric stenosis involves a physical obstruction at the stomach outlet, leading to forceful expulsion of contents.
Eliminate the other options: Hernia and appendicitis do not typically cause projectile vomiting, and the vomiting in imperforate anus is a later, bilious sign of a more distal obstruction.
Conclude that pyloric stenosis is the condition most characteristically associated with projectile vomiting.

Concept Tested & Keywords

Concept Tested: Clinical signs of pediatric gastrointestinal disorders
Stem keywords: Projectile vomiting, characteristic
Lead-in keywords: which of the following
Clinical cues: The image of an infant with forceful vomiting is a strong visual cue for projectile vomiting.

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

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