Which of the following is most common clinical manifestation of pyloric stenosis in children?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2023

Child Health Nursing (Pediatrics)

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2023

Explanation

Hypertrophic pyloric stenosis involves the thickening of the pyloric muscle, which creates a physical blockage at the stomach's outlet.
The stomach's muscles contract powerfully to try and force food through the narrowed channel.
This forceful contraction results in the hallmark sign of progressive, non-bilious, projectile vomiting, which typically begins around 3-6 weeks of age.
The infant remains hungry after vomiting because the feed never reached the intestines for absorption.

Option A: Diarrhea is incorrect because the gastric outlet obstruction prevents or significantly reduces the passage of chyme into the intestines, leading to constipation or decreased stool frequency.
Option B: Increased urine output is incorrect. The persistent vomiting causes significant fluid loss, leading to dehydration. The body's compensatory mechanism is to conserve water, resulting in decreased urine output (oliguria).
Option D: Weight gain is incorrect. The infant cannot retain feedings due to persistent vomiting, leading to a lack of nutrient absorption, malnutrition, and subsequent weight loss or failure to thrive.

Clinical Relevance

Nursing practice connection: Knowing Clinical manifestations of hypertrophic pyloric stenosis helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must recognize projectile vomiting in an infant as a potential sign of pyloric stenosis to facilitate prompt diagnosis and prevent severe dehydration and electrolyte imbalance.
Pre-operative nursing care is critical and focuses on correcting fluid deficits and the characteristic hypochloremic, hypokalemic metabolic alkalosis with IV fluids before the infant undergoes surgery (pyloromyotomy).
Post-operative management includes a carefully graded feeding plan, starting with small, frequent feeds to ensure tolerance and prevent stress on the surgical site.

How to Approach the Question

First, identify the key term in the question: 'pyloric stenosis'.
Recall the basic pathophysiology of this condition: a thickening of the muscle at the stomach's exit, causing a blockage.
Think logically about the consequence of a blockage at the stomach outlet. Food cannot move forward, so it must be expelled backward with force.
Evaluate each option against this understanding:
Diarrhea: Unlikely, as food isn't reaching the intestines.
Increased urine output: Unlikely, as vomiting causes fluid loss.

Concept Tested & Keywords

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