NORCET 9 Mains - 2025: Which of the following is a key clinical sign of congenital hypertrophic pyloric stenosis in infants?

NORCET 9 Mains - 2025

Child Health Nursing (Pediatrics)

Easy

Appeared in: NORCET 9 Mains - 2025

Explanation

The correct option identifies the two hallmark signs of congenital hypertrophic pyloric stenosis (CHPS): non-bilious projectile vomiting and a palpable olive-shaped mass.
Vomiting is non-bilious because the pyloric obstruction is proximal to the ampulla of Vater, where bile enters the duodenum. The stomach's forceful contractions against the obstruction cause the vomit to be projectile.
The palpable 'olive' is the thickened pyloric muscle itself. It is a pathognomonic sign, though not always palpable, especially with early diagnosis via ultrasound.
Infants with CHPS are characteristically hungry after vomiting, a key differentiator from illnesses causing anorexia.

Option A: Bile-stained (bilious) vomitus indicates an obstruction located distal to the ampulla of Vater, allowing bile to mix with gastric contents. In CHPS, the obstruction is proximal to this point.
Option C: Significant abdominal distension and constipation are signs of a lower gastrointestinal obstruction, not a gastric outlet obstruction like CHPS. In CHPS, the abdomen is typically flat or even scaphoid due to vomiting.
Option D: Watery diarrhea is the primary symptom of gastroenteritis, not CHPS. While dehydration is a consequence of the persistent vomiting in CHPS, diarrhea is not a feature.

Clinical Relevance

Nursing practice connection: Knowing Clinical presentation of congenital hypertrophic pyloric stenosis helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Early recognition of non-bilious projectile vomiting is critical for nurses to prevent severe dehydration and electrolyte imbalances (hypochloremic, hypokalemic metabolic alkalosis).
Nursing care for an infant with CHPS involves strict intake and output monitoring, preparing the infant and family for surgery (pyloromyotomy), and managing post-operative feeding protocols.
What if the vomitus was bile-stained? A nurse must recognize this as a red flag for a different, potentially more urgent, surgical emergency like malrotation with volvulus. This requires immediate escalation to the medical team as it can lead to bowel ischemia.

How to Approach the Question

First, identify the core condition in the question: congenital hypertrophic pyloric stenosis (CHPS).
Recall the pathophysiology: a thickening of the pylorus muscle creates a gastric outlet obstruction.
Analyze the location of the obstruction. Since it's at the stomach outlet, before the entry of the bile duct, the vomit will not contain bile (non-bilious).
Consider the physical exam findings. The thickened muscle can often be palpated as a distinct 'olive-shaped' mass.
Evaluate each option against these key features. Eliminate options that describe signs of lower GI obstruction (distension, constipation), infection (diarrhea), or obstructions distal to the pylorus (bile-stained vomit).

Concept Tested & Keywords

Concept Tested: Clinical presentation of congenital hypertrophic pyloric stenosis
Stem keywords: congenital hypertrophic pyloric stenosis, infants, key clinical sign
Lead-in keywords: Which of the following
Clinical cues: The question specifies an infant, which is the typical age group for this condition.
Negative lead-in flag: false