What is the most characteristic of congenital hyperophic pyloric stenosis:
Correct Answer: The pyloric tumour is best felt during feeding
Description: Answer is B (The pyloric tumor is best felt during feeding) First born male child is characteristically most commonly affected It is four times more common in males as in females . The condition does not present at bih. It is most commonly seen 4 weeks after bih Presentation Vomiting is the presenting symptom (child vomits milk and no bile is presentQ) Immediately after vomiting the child is hungry i.e. loss of appetite does not occur. Weight loss is striking and rapidly the infant becomes emaciated and dehydrated. However, greater awareness of pyloric stenosis has led to earlier identification of patients and hence with fewer incidences of chronic malnutrition and severe dehydration - Nelson 10th/1130 The diagnosis is usually made with a test feed : In this the baby is fed with the bottle by a nurse or mother and surgeon : - palpates the abdomen with a warm hand to detect the lump - observes the characteristic peristatic waves pass across the upper abdomen. Pathologically musculature of pylorus adjacent to antrum is grossly hyperophied Ultrasonographv is the investigation of choice Hyperchloremic alkalosis is common and following diagnosis first concern is to correct metabolic abnormalities -child is rehydrated with dextrose saline & potassiumQ Treatment of choice Ramsted's operation - 'Pyloromyotomy'
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