Pyloric stenosis differential diagnosis

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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

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:

• 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