Pyloric stenosis vs GERD infant
How to tell Pyloric stenosis and GERD infant apart when a board question makes them look alike.
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Projectile progressive nonbilious vomiting with dehydration points to pyloric stenosis.
Side by side
A 2 to 8 week infant with progressively projectile nonbilious vomiting and dehydration suggests pyloric stenosis.
An otherwise thriving infant with effortless post-feed spit-ups and normal growth suggests physiologic infant GERD.
Hypertrophy of the pyloric muscle obstructs gastric outlet emptying.
Transient lower esophageal sphincter relaxation allows gastric reflux without fixed outlet obstruction.
Typical findings include hypochloremic, hypokalemic metabolic alkalosis and ultrasound pyloric muscle thickness at least 3 mm with channel length at least 14 to 17 mm.
Infant GERD usually has normal electrolytes and growth; diagnosis is clinical unless alarm signs prompt further testing.
The trap
Frequent spit-up is assumed to be benign reflux even after weight loss and forceful emesis. Progression to hungry vomiting with alkalosis and an enlarged pylorus on ultrasound identifies obstruction and requires surgery after resuscitation.
The repair move
Next best step: start isotonic IV fluids and correct chloride and potassium deficits before surgery, then perform pyloromyotomy once euvolemic. For uncomplicated infant GERD with normal growth, use feeding and positioning measures rather than operative treatment.
Try a free question
CoreA 6-week-old infant has progressive projectile nonbilious vomiting after feeds and poor weight gain. Chloride is 90 mEq/L and bicarbonate is 33 mEq/L. What is the next best step in management?
Show answer and explanation
Answer: A. Abdominal ultrasound to confirm pyloric stenosis while starting IV fluid resuscitation. Classic pyloric stenosis features require confirmation with ultrasound and prompt stabilization before surgery.
Why the other choices are tempting
- B. Wrong. Acid suppression alone misses evolving gastric outlet obstruction.
- C. Wrong. Feeding challenge worsens dehydration and emesis.
- D. Wrong. Endoscopy is not first-line for typical pyloric stenosis presentation.
- E. Wrong. Progressive projectile emesis with alkalosis is not benign reflux.
Flashcards
Tap a card to flip it.
Which vomiting pattern in a young infant should trigger concern for pyloric stenosis?
Progressive forceful projectile nonbilious emesis with persistent hunger afterward.
What growth and exam profile fits uncomplicated infant GERD?
Effortless regurgitation in a thriving infant with normal hydration and weight gain.
Quick answers
What is the fastest way to tell Pyloric stenosis from GERD infant?
Projectile progressive nonbilious vomiting with dehydration points to pyloric stenosis.
What is the key clue for Pyloric stenosis?
A 2 to 8 week infant with progressively projectile nonbilious vomiting and dehydration suggests pyloric stenosis.
What is the key clue for GERD infant?
An otherwise thriving infant with effortless post-feed spit-ups and normal growth suggests physiologic infant GERD.
What is the common trap with Pyloric stenosis vs GERD infant?
Frequent spit-up is assumed to be benign reflux even after weight loss and forceful emesis. Progression to hungry vomiting with alkalosis and an enlarged pylorus on ultrasound identifies obstruction and requires surgery after resuscitation.