Pyloric stenosis differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Pyloric_stenosis_surgery]] | |||
{{CMG}}; {{AE}} {{MMJ}} | {{CMG}}; {{AE}} {{MMJ}} | ||
==Overview== | ==Overview== | ||
Infantile hypertrophic pyloric stenosis must be differentiated from other diseases that cause [[vomiting]], [[poor feeding]] and [[dehydration]], such as [[adrenal insufficiency]], [[gastroenteritis]], [[UTI]], [[inborn errors of metabolism]] and [[acute renal failure]]. projectile vomiting and and palpation of an olive in abdominal physical examination are very helpful to distinguish infantile pyloric stenosis from other common causes of vomiting in infants. | |||
==Differentiating Pyloric | ==Differentiating Infantile Pyloric stenosis from Other Diseases== | ||
Pyloric stenosis must be differentiated from other diseases, such as: | Pyloric stenosis must be differentiated from other diseases, such as:<ref name="PuttannaCunningham2013">{{cite journal|last1=Puttanna|first1=A.|last2=Cunningham|first2=A. R.|last3=Dainty|first3=P.|title=Addison's disease and its associations|journal=Case Reports|volume=2013|issue=jul26 1|year=2013|pages=bcr2013010473–bcr2013010473|issn=1757-790X|doi=10.1136/bcr-2013-010473}}</ref><ref name="Elliott2007">{{cite journal|last1=Elliott|first1=E. J.|title=Acute gastroenteritis in children|journal=BMJ|volume=334|issue=7583|year=2007|pages=35–40|issn=0959-8138|doi=10.1136/bmj.39036.406169.80}}</ref><ref name="Gil-RuizAlcaraz2011">{{cite journal|last1=Gil-Ruiz|first1=Maite Augusta|last2=Alcaraz|first2=Andrés José|last3=Marañón|first3=Rafael José|last4=Navarro|first4=Nelia|last5=Huidobro|first5=Belén|last6=Luque|first6=Augusto|title=Electrolyte disturbances in acute pyelonephritis|journal=Pediatric Nephrology|volume=27|issue=3|year=2011|pages=429–433|issn=0931-041X|doi=10.1007/s00467-011-2020-9}}</ref><ref name="pmid3317287">{{cite journal| author=Chambers JK| title=Fluid and electrolyte problems in renal and urologic disorders. | journal=Nurs Clin North Am | year= 1987 | volume= 22 | issue= 4 | pages= 815-26 | pmid=3317287 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3317287 }} </ref> | ||
* [[Adrenal Insufficiency|Adrenal insufficiency]] | * [[Adrenal Insufficiency|Adrenal insufficiency]] | ||
* [[Gastroenteritis]] | * [[Gastroenteritis]] | ||
* Inborn errors of | * [[Inborn errors of metabolism]] | ||
* [[Urinary Tract Infections|Urinary tract infections]] and [[ | * [[Urinary Tract Infections|Urinary tract infections]] and [[pyelonephritis]] | ||
* [[ | * [[Acute renal failure]] | ||
==Preferred Table== | ==Preferred Table== | ||
| Line 19: | Line 19: | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! rowspan="2" |Diseases | ! rowspan="2" |Diseases | ||
! colspan=" | ! colspan="3" |History and Symptoms | ||
! colspan="2" |Physical Examination | |||
! colspan="3" |Laboratory Findings | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
!Vomiting | |||
!Persistent hunger | |||
!Failure to gain weight | |||
!Dehydration | !Dehydration | ||
!Palpation of an olive in abdomen | |||
!Hypokalemia | !Hypokalemia | ||
!Acidosis or Alkalosis | !Acidosis or Alkalosis | ||
!Hypochloremia or hyperchloremia | !Hypochloremia or hyperchloremia | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Infantile pyloric stenosis''' | ||
| style="background: #F5F5F5; padding: 5px;" | ++ | | style="background: #F5F5F5; padding: 5px; text-align: center;" | ++ | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | ++ | ||
| style="background: #F5F5F5; padding: 5px;" |Alkalosis | | style="background: #F5F5F5; padding: 5px; text-align: center;" | ++ | ||
| style="background: #F5F5F5; padding: 5px;" | Hypochloremia | | style="background: #F5F5F5; padding: 5px; text-align: center;" | ++ | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Alkalosis]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Hypochloremia]] | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Adrenal | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adrenal insufficiency|'''Adrenal insufficiency''']] | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" |Hyperkalemia | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" |Acidosis | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | Hypochloremia | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Hyperkalemia]] or normal | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Acidosis]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Hypochloremia]] | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Gastroenteritis | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastroenteritis|'''Gastroenteritis''']] | ||
| style="background: #F5F5F5; padding: 5px;" | ++ | | style="background: #F5F5F5; padding: 5px; text-align: center;" | ++ | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" |Acidosis | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | Hypochloremia | | style="background: #F5F5F5; padding: 5px; text-align: center;" | ++ | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Acidosis]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Hypochloremia]] | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |UTI | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[UTI|'''UTI''']] | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | Acidosis or alkalosis | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | Hypochloremia or hyperchloremia | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Acidosis]] or [[alkalosis]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Hypochloremia]] or [[hyperchloremia]] | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Acute renal failure | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Acute renal failure|'''Acute renal failure''']] | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" |Hyperkalemia | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" |Acidosis | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Hyperkalemia]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Acidosis]] | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Hyperchloremia]] | |||
|} | |} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Surgery]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Disease]] | |||
[[Category:Pediatrics]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Differential diagnosis]] | |||
Latest revision as of 22:03, 7 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Infantile hypertrophic pyloric stenosis must be differentiated from other diseases that cause vomiting, poor feeding and dehydration, such as adrenal insufficiency, gastroenteritis, UTI, inborn errors of metabolism and acute renal failure. projectile vomiting and and palpation of an olive in abdominal physical examination are very helpful to distinguish infantile pyloric stenosis from other common causes of vomiting in infants.
Differentiating Infantile Pyloric stenosis from Other Diseases
Pyloric stenosis must be differentiated from other diseases, such as:[1][2][3][4]
- Adrenal insufficiency
- Gastroenteritis
- Inborn errors of metabolism
- Urinary tract infections and pyelonephritis
- Acute renal failure
Preferred Table
| Diseases | History and Symptoms | Physical Examination | Laboratory Findings | |||||
|---|---|---|---|---|---|---|---|---|
| Vomiting | Persistent hunger | Failure to gain weight | Dehydration | Palpation of an olive in abdomen | Hypokalemia | Acidosis or Alkalosis | Hypochloremia or hyperchloremia | |
| Infantile pyloric stenosis | ++ | ++ | ++ | ++ | +/- | + | Alkalosis | Hypochloremia |
| Adrenal insufficiency | +/- | +/- | + | + | - | Hyperkalemia or normal | Acidosis | Hypochloremia |
| Gastroenteritis | ++ | - | +/- | ++ | - | + | Acidosis | Hypochloremia |
| UTI | +/- | - | - | +/- | - | + | Acidosis or alkalosis | Hypochloremia or hyperchloremia |
| Acute renal failure | +/- | - | - | + | - | Hyperkalemia | Acidosis | Hyperchloremia |
References
- ↑ Puttanna, A.; Cunningham, A. R.; Dainty, P. (2013). "Addison's disease and its associations". Case Reports. 2013 (jul26 1): bcr2013010473–bcr2013010473. doi:10.1136/bcr-2013-010473. ISSN 1757-790X.
- ↑ Elliott, E. J. (2007). "Acute gastroenteritis in children". BMJ. 334 (7583): 35–40. doi:10.1136/bmj.39036.406169.80. ISSN 0959-8138.
- ↑ Gil-Ruiz, Maite Augusta; Alcaraz, Andrés José; Marañón, Rafael José; Navarro, Nelia; Huidobro, Belén; Luque, Augusto (2011). "Electrolyte disturbances in acute pyelonephritis". Pediatric Nephrology. 27 (3): 429–433. doi:10.1007/s00467-011-2020-9. ISSN 0931-041X.
- ↑ Chambers JK (1987). "Fluid and electrolyte problems in renal and urologic disorders". Nurs Clin North Am. 22 (4): 815–26. PMID 3317287.