Quiz: Newborn patients with reports of non-biliary vomiting after breastfeeding. What is that?

correct

reply: THE

The first test to evaluate persistent vomiting in a pediatric population is an abdominal ultrasonography.

correct

Answer: c) Pylorus, stenosis Hopeful Of the pylorus

The pyloric canal is still elongated, with a vertical axis length of 19 mm and a yellow arrow.

Hypertrophic pyloric stenosis is a disease characterized by hypertrophy of the circular muscles of the pylorus, resulting in stenosis of the pyloric canal and obstruction of the gastric outlet. Boys are affected by a 4-5: 1 ratio more than girls. Patients usually show nonbiliary vomiting at 2-6 weeks of age. A clinical diagnosis can be made by palpating the olive-shaped “lumps” of the epigastrium (pyloric olives). You may also see a fight against gastric peristalsis. However, these endoscopic and laboratory findings occur only in about 17-53% of patients.

Ultrasonography is the imaging test of choice to diagnose this condition. Your baby should be breastfed approximately 30 minutes before the test so that the pyloric antrum is filled with liquid and the pylorus can be properly visualized. Thickened pyloric muscles and elongated pyloric canals are observed in the long axis of the pylorus. References are: Normal pyloric canal is up to 12-14 mm and normal muscle thickness is up to 3 mm.

reference:

• Hernanz-Schulman M, Zhu Y, Stein SM, Others Hypertrophic pyloric stenosis in infants: US assessment of vascular distribution in the pyloric canal. Radiology 2003; 229: 389-393.
• Haider N, Spicer R, Grier D. Ultrasonography of infantile hypertrophic pyloric stenosis: determinants of pyloric length and effects of premature babies. Clin Radiol 2002, 57: 136-139.
• Gale HI, Gee MS, Westra SJ, etc. Abdominal ultrasonography of the pediatric gastrointestinal tract. World J Radiol 2016; 8: 656-667.
• Peeters B, Benninga Ma, Hennekam RC Infant Hypertrophic Pyloric Stenosis – Genetics and Syndrome. Nat Rev Gastroenterol Hepatol 2012: 9: 646-660.