Pyloric stenosis Quiz: Ace Your Exams

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A 6-week-old girl presents to the emergency department (ED) with recurrent postprandial emesis. She was born at term via cesarean section, has no known medical conditions and is primarily formula-fed. Her parents report that she has had intermittent episodes of non-bilious postprandial emesis since birth, but over the last several days they have become more frequent and forceful, even “shooting across the room” per her parent. She was seen by her pediatrician two days ago and an alternative formula was recommended; however, her symptoms have persisted. Her last wet diaper was approximately 8 hours ago and her last bowel movement occurred yesterday and was normal in character. In the ED, her temperature is 36.2 °C (97.2 ºF), pulse is 165/min, blood pressure is 68/35 mmHg, and SpO2 is 99%. Results of laboratory studies are shown. Abdominal ultrasound shows a target sign. What is the most likely cause of this patient’s symptoms?  

Laboratory value
Result
Complete Metabolic Panel  

Sodium
138 mEq/L
Potassium
3.4 mEq/L
Chloride
88 mEq/L
CO2
30 mEq/L
Creatinine
0.29 mg/dL
BUN
9 mg/dL
Total bilirubin
4.9 mg/dL
Direct bilirubin
0.1 mg/dL
Complete blood count

Leukocyte Count
6.3 g/dL
Hemoglobin
13.2 g/dL
Hematocrit
39.6 %
Platelet Count
270,000/mm3

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