Pyloric stenosis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Patients with infantile pyloric stenosis usually appear ill. Physical examination of patients with infantile pyloric stenosis is usually remarkable for palpation of an abdominal mass in epigastrium.This mass, which consists of the enlarged pylorus, is referred to as the olive.

Hypothermia and tachycardia with regular pulse and tachypnea may be present. In skin examination cyanosis, poor skin turgur, jaundice and pallor may be present.

Physical Examination

The presence of palpation of an abdominal mass and visible peristalsis on physical examination is diagnostic of infantile pyloric stenosis.

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Vital Signs

• Hypothermia may be present
• Tachycardia with regular pulse may be present due to dehydration
• Tachypnea may be present due to dehydration

Skin

• Cyanosis may be present due to dehydration

• Poor skin turgur may be present due to dehydration

• Jaundice may be present

HEENT

• Depressed fontanelles may be present due to dehydration
• Decereased tearing may be present due to dehydration

Neck

Physical examination of neck is usually normal.

Lungs

Physical examination of lungs is usually normal.

Heart

Physical examination of heart is usually normal.

Abdomen

• Palpation of the abdomen may reveal a mass in the epigastrium. This mass, which consists of the enlarged pylorus, is referred to as the olive and is sometimes evident after the infant is given formula to drink. It is an elusive diagnostic skill requiring much patience and experience.
• Palpation of a hypertrophied pylorus is very diagnostic in diagnosis of hypertrophic pyloric stenosis.
• There are often palpable (or even visible) peristaltic waves due to stomach trying to force its contents past the narrowed pyloric outlet.

Back

Physical examination of back is usually normal.

Genitourinary

Physical examination of genitourinary system is usually normal.

Neuromuscular

Physical examination of neuromuscular system is usually normal.

Extremities

Physical examination of extremities is usually normal.