CLIPP 15 - pyloric Stenosis

Question 1

DDX infant vomiting (8)

Answer 1

• Gastroesophageal reflux
• Viral gastroenteritis
• malrotation/volvulus
• inborn error of metabolism
• pyloric stenosis
• intussusception
• CNS disease
• UTI

Question 2

indications for oral vs parenteral replacement therapy

Answer 2

parenteral: severe dehydration, repeated 10-20mL/kg boluses of isotonic solution
oral: mild-moderate dehydration

Question 3

Best prevention against transmission of viral gastroenteritis

Answer 3

Good handwashing

Question 4

electrolyte abnormalities in pyloric stenosis (3)

Answer 4

hypochloremic, hypokalemic metabolic acidosis

Question 5

Questions for assessing vomiting (6)

Answer 5

• sick contacts
• significant abdominal pain
• character of emesis
• character of stool
• fever
• eating/drinking

Question 6

Questions for assessing hydration status (2)

Answer 6

• level of activity

- ability and/or desire to take fluids by mouth

Question 7

Rehydration volume calculation

Answer 7

mild-moderate: 50-100mL/kg

Question 8

Pyloric Stenosis workup (3)

Answer 8

• pyloric US (pyloric hypertrophy)
• Upper GI contrast study (“string sign”)
• electrolytes: hypochloremia, hypokalemia, alkalosis