Pyloric stenosis vs Duodenal and jejunal atresia
How to tell Pyloric stenosis and Duodenal and jejunal atresia apart when a board question makes them look alike.
Pyloric stenosis is nonbilious projectile vomiting weeks later; duodenal/jejunal atresias cause early bilious obstruction patterns.
Side by side
Pyloric stenosis causes nonbilious projectile vomiting at weeks of life, olive-like mass, hypochloremic metabolic alkalosis, and ultrasound target sign.
Duodenal atresia causes bilious vomiting and double bubble, associated with Down syndrome; jejunal atresia causes bilious vomiting with triple bubble or apple-peel pattern.
Pyloric stenosis causes nonbilious projectile vomiting at weeks of life, olive-like mass, hypochloremic metabolic alkalosis, and ultrasound target sign.
Duodenal atresia causes bilious vomiting and double bubble, associated with Down syndrome; jejunal atresia causes bilious vomiting with triple bubble or apple-peel pattern.
The repair move
Before naming the answer, force the stem through the separator: Pyloric stenosis is nonbilious projectile vomiting weeks later; duodenal/jejunal atresias cause early bilious obstruction patterns.
Try a free question
CoreA 5-week-old first-born male infant has had 1 week of progressively projectile non-bilious vomiting after every feed. He is hungry and eager to feed again immediately after vomiting. On examination, a small olive-shaped mobile mass is palpable in the right upper quadrant just below the liver edge. Labs: chloride 89, potassium 3.0, bicarbonate 32, pH 7.50. Which condition is most likely?
Show answer and explanation
Answer: A. Hypertrophic pyloric stenosis. Hypertrophic pyloric stenosis presents at 3-6 weeks of age (more common in first-born males) with projectile non-bilious vomiting, palpable olive in epigastrium, and hypochloremic hypokalemic metabolic alkalosis from loss of gastric HCl. Ultrasound shows pyloric thickening (>4 mm) and elongation (>16 mm). Treat with pyloromyotomy (Ramstedt).
Why the other choices are tempting
- B. Duodenal atresia causes BILIOUS vomiting in the first day of life with double-bubble sign and Down syndrome association.
- C. Jejunal atresia causes bilious vomiting and triple-bubble or apple-peel pattern from in utero vascular accident.
- D. Malrotation with volvulus presents with bilious vomiting and is a surgical emergency.
- E. Necrotizing enterocolitis is bloody stools, abdominal distention, pneumatosis intestinalis in premature neonates.
Flashcards
Tap a card to flip it.
What clue supports Pyloric stenosis?
Choose Pyloric stenosis when the stem gives this pattern: Pyloric stenosis causes nonbilious projectile vomiting at weeks of life, olive-like mass, hypochloremic metabolic alkalosis, and ultrasound target sign.
What clue supports Duodenal and jejunal atresia?
Choose Duodenal and jejunal atresia when the stem gives this contrasting pattern: Duodenal atresia causes bilious vomiting and double bubble, associated with Down syndrome; jejunal atresia causes bilious vomiting with triple bubble or apple-peel pattern.
Quick answers
What is the fastest way to tell Pyloric stenosis from Duodenal and jejunal atresia?
Pyloric stenosis is nonbilious projectile vomiting weeks later; duodenal/jejunal atresias cause early bilious obstruction patterns.
What is the key clue for Pyloric stenosis?
Pyloric stenosis causes nonbilious projectile vomiting at weeks of life, olive-like mass, hypochloremic metabolic alkalosis, and ultrasound target sign.
What is the key clue for Duodenal and jejunal atresia?
Duodenal atresia causes bilious vomiting and double bubble, associated with Down syndrome; jejunal atresia causes bilious vomiting with triple bubble or apple-peel pattern.