Projectile vomiting is seen in:

IGNOU PB Bsc Nsg.Entrance-2026

Child Health Nursing (Pediatrics)

Easy

Appeared in: IGNOU PB Bsc Nsg.Entrance-2026

Explanation

Projectile vomiting is the hallmark symptom of hypertrophic pyloric stenosis, a condition seen in infants.
This forceful emesis occurs because the stomach muscles contract powerfully to try and push contents through the narrowed pyloric outlet.
The vomitus is characteristically non-bilious (not containing bile) because the obstruction is proximal to the duodenum, where bile is secreted.
Infants with pyloric stenosis are often described as being 'hungry vomiters' because they are eager to feed again immediately after an episode.

Option B: Megacolon (Hirschsprung disease) causes a distal bowel obstruction. The primary signs are failure to pass meconium, abdominal distension, and bilious vomiting, not projectile vomiting.
Option C: Volvulus is an acute twisting of the intestine. It presents as a surgical emergency with sudden, severe abdominal pain and bilious vomiting due to the obstruction being lower in the GI tract.
Option D: Appendicitis is characterized by migrating abdominal pain (periumbilical to RLQ), fever, and nausea. While vomiting can occur, it is typically not forceful or projectile.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical manifestations of congenital gastrointestinal obstructions as background academic context rather than a clinical decision trigger.
A nurse's ability to recognize projectile vomiting in an infant as a key sign of pyloric stenosis is critical for early diagnosis and intervention, preventing severe dehydration and metabolic disturbances.
Pre-operative nursing care is focused on patient safety by maintaining NPO status, managing IV fluids to correct dehydration, and monitoring electrolytes to stabilize the infant for surgery (pyloromyotomy).
Post-operative care involves a careful, graded re-introduction of feedings to prevent stress on the surgical site and ensure the infant can tolerate nutrition.

How to Approach the Question

First, identify the key clinical sign presented in the question stem: 'Projectile vomiting'.
Next, consider the typical age group for this symptom. While not stated, projectile vomiting is a classic sign in infancy.
Systematically review the options and recall the hallmark presentations of each condition.
Pyloric stenosis is classically associated with non-bilious, projectile vomiting in infants around 3-6 weeks of age.
Megacolon and volvulus typically present with bilious vomiting because the obstruction is lower in the GI tract.
Appendicitis is associated with mild vomiting, not projectile vomiting. Therefore, pyloric stenosis is the most fitting diagnosis.

Concept Tested & Keywords

Concept Tested: Clinical manifestations of congenital gastrointestinal obstructions
Stem keywords: Projectile vomiting
Lead-in keywords: BEST, MOST RELEVANT CLUE
Negative lead-in flag: false

QMlR8PvcD_jYP6sVJpTQ48

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

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