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Hypertrophic pyloric stenosis — RACP Paediatrics MCQ

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ModerateGastroenterologyHypertrophic pyloric stenosisRACP Paediatrics

A 5-week-old boy has progressive non-bilious projectile vomiting after feeds. He is hungry after vomiting; examination shows mild dehydration and a palpable epigastric olive. Blood gas shows hypochloraemic metabolic alkalosis. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Correct dehydration and electrolytes before pyloromyotomy

Hypertrophic pyloric stenosis requires resuscitation and correction of hypochloraemic alkalosis before definitive pyloromyotomy. Surgery before electrolyte correction increases anaesthetic risk. The pearl is that pyloric stenosis is a medical resuscitation problem before it is a surgical procedure.

Reference: RCH Clinical Practice Guidelines: Pyloric stenosis; Therapeutic Guidelines (eTG)