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Pyloric stenosis — RACP Paediatrics MCQ

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EasyGIPyloric stenosisRACP Paediatrics

A 4-week-old male infant presents with non-bilious projectile vomiting after every feed for the past week. He is hungry immediately after vomiting. Examination reveals visible gastric peristalsis and a palpable olive-shaped mass in the right upper quadrant. What is the most likely diagnosis?

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Correct answer: E — Pyloric stenosis

Non-bilious projectile vomiting in a 3-6 week old (classically male firstborn), hunger post-vomiting, visible peristalsis, and a palpable pyloric 'olive' are pathognomonic for pyloric stenosis. Diagnosis is confirmed by ultrasound (pyloric muscle thickness ≥3 mm, length ≥15 mm). Management is Ramstedt pyloromyotomy after correction of hypochloraemic hypokalaemic metabolic alkalosis.

Reference: RCH Melbourne – 2024 – Pyloric Stenosis CPG