Ch. 329.1 - Hypertrophic Pyloric Stenosis

Question 1

T/F Hypertrophic pyloric stenosis (HPS) is rare in Asians and more common in whites

Answer 1

T

Question 2

HPS: Gender

Answer 2

M, especially firstborns

Question 3

T/F: Offsprings of a mother and to a lesser extent the father who had pyloric stenosis are at higher risk for pyloric stenosis

Answer 3

T

Question 4

Incidence of pyloric stenosis is increased with infants with what blood groups

Answer 4

B and O

Question 5

Syndromes associated with pyloric stenosis

Answer 5

1) Eosinophilic gastroenteritis 2) Apert syndrome 3) Zellweger syndrome 4) Trisomy 18 5) Smith-Lemli-Opitz syndrome 6) Cornelia de Lange syndrome

Question 6

Use of this drug is associated with risk of pyloric stenosis

Answer 6

Erythromycin, especially if given with 1st 2 weeks of life

Question 7

Higher risk of pyloric stenosis is seen in female infants of mothers treated with ___ during pregnancy and breastfeeding

Answer 7

Macrolide antibiotics

Question 8

Reduced levels of this substance is implicated in the pathogenesis of pyloric stenosis

Answer 8

Nitric oxide

Question 9

Initial symptom of pyloric stenosis

Answer 9

Nonbilious vomiting, which may or may not be projectile initially but is usually progressive, occurring immediately after feeding

Question 10

Vomiting in infants with pyloric stenosis usually starts at what age

Answer 10

3 weeks of age, but can develop as early as a week and as late as 5th month

Question 11

Acid base abnormality seen in patients with pyloric stenosis with persistent vomiting

Answer 11

Hypochloremic metabolic alkalosis

Question 12

MC clinical association of pyloric stenosis

Answer 12

Hyperbilirubinemia aka icteropyloric syndrome

Question 13

T/F In icteropyloric syndrome, unconjugated hyperbilirubinemia is more common than conjugated

Answer 13

T

Question 14

T/F Hyperbilirubinemia in icteropyloric syndrome usually resolves with surgical correction

Answer 14

T

Question 15

Characteristics of the pyloric mass

Answer 15

Firm, movable, approx 2 cm in length, olive-shaped, hard, best palpated from the left side, and located above and to the right of the umbilicus in the midepigastrium beneath the liver’s edge

Question 16

The pyloric “olive” is easiest palpated when

Answer 16

After an episode of vomiting

Question 17

Diagnostic tool that confirms the diagnosis of pyloric stenosis in majority of cases

Answer 17

UTZ, sensitivity of approx 95%

Question 18

Contrast studies of pyloric stenosis shows

Answer 18

1) String sign or an elongated pyloric channel; 2) shoulder sign or bulge of pyloric muscle into the antrum; 3) double tract sign or parallel streaks of barium seen in the narrowed channel

Question 19

Preoperative treatment of pyloric stenosis is directed toward

Answer 19

Correcting fluid, acid-base, and electrolyte imbalance

Question 20

Surgical procedure of choice for pyloric stenosis

Answer 20

Pyloromyotomy (Ramstedt procedure)

Question 21

Successful management modality of infants with persistent vomiting secondary to incomplete pyloromyotomy

Answer 21

Endoscopic balloon dilation

Question 22

Advisable mode of management for patients with pyloric stenosis who are not good surgical candidates

Answer 22

Nasoduodenal feedings

Question 23

Pyloric muscle relaxant used in patients with pyloric stenosis when surgical treatment is not available

Answer 23

Atropine sulfate