The main clinical feature of pyloric stenosis?

IGIMS Staff Nurse - 2018

Child Health Nursing (Pediatrics)

Easy

Appeared in: IGIMS Staff Nurse - 2018

Explanation

The hallmark sign of hypertrophic pyloric stenosis is projectile vomiting, which is forceful and non-bilious.
This occurs due to the thickening (hypertrophy) of the pyloric sphincter muscle, causing a gastric outlet obstruction.
The stomach's forceful peristaltic contractions attempting to push contents past the obstruction result in the projectile nature of the emesis.
Vomiting typically begins around 3 weeks of age and progressively worsens.
Despite the vomiting, the infant remains hungry and is eager to feed again, a key diagnostic clue.

Option A: Fever is not a feature of pyloric stenosis, which is a mechanical obstruction, not an inflammatory or infectious condition. The presence of fever would point towards other diagnoses like gastroenteritis or sepsis.
Option B: Air hunger (Kussmaul breathing) is a compensatory mechanism for metabolic acidosis. Pyloric stenosis causes the loss of stomach acid, leading to hypochloremic metabolic alkalosis, the opposite condition.
Option C: Infants with pyloric stenosis typically suffer from constipation due to dehydration from the persistent vomiting. While small, infrequent stools called 'starvation diarrhea' can occur, significant diarrhea is not a characteristic symptom.

Clinical Relevance

Nursing practice connection: Knowing The primary clinical manifestation of hypertrophic pyloric stenosis in infants helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing priority is assessing for signs of dehydration and electrolyte imbalance (hypochloremic metabolic alkalosis) in an infant with suspected pyloric stenosis.
Pre-operatively, nurses are responsible for administering IV fluids to correct dehydration and electrolyte disturbances, maintaining NPO status, and monitoring intake and output.
Post-operatively, the nurse's role involves careful reintroduction of feedings, monitoring for any continued vomiting, and assessing the surgical site for signs of infection.

How to Approach the Question

First, identify the keywords in the question: 'main clinical feature' and 'pyloric stenosis'. This directs you to recall the hallmark signs of this specific pediatric condition.
Think about the pathophysiology: Pyloric stenosis is a physical blockage at the stomach outlet. What would be the most direct result of this blockage?
Evaluate each option based on this pathophysiology. Food cannot exit the stomach normally, so it must come back up forcefully. This points directly to projectile vomiting.
Consider the other options. Fever suggests infection. Air hunger suggests metabolic acidosis. Diarrhea is the opposite of what's expected (constipation from dehydration). These do not fit the mechanical obstruction of pyloric stenosis.
Select the option that is the most direct and classic consequence of the disease process.

Concept Tested & Keywords

Concept Tested: The primary clinical manifestation of hypertrophic pyloric stenosis in infants.
Stem keywords: pyloric stenosis, clinical feature
Lead-in keywords: main

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