Pediatric Medicine

Answer 1 Pyloric stenosis. This patient has classic symptoms of pyloric stenosis: a generally well-appearing child aged 2 to 8 weeks with vomiting that increases steadily over time and becomes more forceful or “projectile.” The finding of an “olive-sized” mass in the epigastric area is pathognomic for this condition. Gastroesophageal reflux is common in infants but generally presents at an earlier age, tends to improve rather than worsen with time, and is not associated with an abdominal mass. Intussusception generally presents with colicky pain that tends to wax and wane along with bilious emesis. Volvulus is also associated with bilious vomiting and generally presents with sudden abdominal pain. While patients with Hirschsprung’s disease may vomit, constipation is the more common presenting symptom. SUGGESTED READING Behrman RE, Kliegman RM, Jenson HB, editors. Nelson textbook of pediatrics. 17th ed. Philadelphia: Saunders; 2004. Click here to return to the questions

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