Which sign or symptom would you expect to find in an infant with pyloric stenosis?

HPSSC - 2015

Child Health Nursing (Pediatrics)

Easy

Appeared in: HPSSC - 2015

Explanation

Projectile vomiting is the classic and initial symptom of pyloric stenosis.
It is caused by the forceful contraction of the stomach against a narrowed and obstructed pyloric outlet.
The vomiting is characteristically non-bilious (not containing bile) because the obstruction is proximal to the ampulla of Vater, where bile enters the duodenum.
Infants with pyloric stenosis are often hungry immediately after vomiting and eager to feed again.

Option A: Diarrhea is not a symptom of pyloric stenosis. In fact, constipation is more common due to the reduced amount of food reaching the intestines for digestion and absorption.
Option C: Vomiting of bile (bilious vomiting) indicates an obstruction distal to (beyond) the ampulla of Vater, where the bile duct enters the small intestine. In pyloric stenosis, the obstruction is proximal to this point.
Option D: Anemia is not a direct or early symptom of pyloric stenosis. While chronic malnutrition from persistent vomiting could eventually lead to anemia, it is not a presenting sign. The immediate concerns are dehydration and electrolyte imbalances.

Clinical Relevance

Nursing practice connection: Use the key finding related to The primary clinical manifestation of hypertrophic pyloric stenosis in infants to guide bedside assessment, documentation, and the next nursing action.
Early recognition of projectile vomiting is crucial for timely diagnosis and management of pyloric stenosis, preventing severe dehydration and electrolyte disturbances.
Nursing priorities include maintaining NPO (nothing by mouth) status, initiating intravenous fluids to correct dehydration and metabolic alkalosis, and monitoring intake and output.
The definitive treatment is a surgical procedure called a pyloromyotomy. The nurse's role is vital in preparing the infant for surgery and providing postoperative care.

How to Approach the Question

First, identify the core concept of the question, which is the clinical presentation of 'pyloric stenosis' in an 'infant'.
Recall the pathophysiology of pyloric stenosis: hypertrophy of the pyloric muscle creates a gastric outlet obstruction.
Think about the consequence of this blockage. Food cannot easily leave the stomach, leading to forceful expulsion.
Evaluate the options based on this pathophysiology. 'Projectile vomiting' is a direct result of the stomach's forceful contractions against the obstruction.
Eliminate other options. 'Diarrhea' is unlikely as little food passes the obstruction. 'Vomiting of bile' is incorrect because the blockage is before the bile duct entrance. 'Anemia' is a chronic issue, not an acute presenting sign.

Concept Tested & Keywords

Concept Tested: The primary clinical manifestation of hypertrophic pyloric stenosis in infants.
Stem keywords: infant, pyloric stenosis, sign, symptom
Lead-in keywords: expect to find
Clinical cues: The question asks for a characteristic sign in an infant, pointing towards a common congenital condition of that age group.

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