Which physical findings are characteristic of pediatric pyloric stenosis?

Updated: Nov 13, 2018
  • Author: Sathyaseelan Subramaniam, MD, FAAP; Chief Editor: Kirsten A Bechtel, MD  more...
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Answer

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  • In as many as 60-80% of the infants with infantile hypertrophic pyloric stenosis (IHPS), a firm, nontender, and mobile hard pylorus that is 1-2 cm in diameter, described as an "olive," may be present in the right upper quadrant at the lateral edge of the rectus abdominis muscle. This is best palpated after the infant has vomited and when calm, or when the gastric contents have been removed via nasogastric tube. The palpation of an olive mass has a 99% positive predictive value for IHPS diagnosis. [13]
  • Clinicians may also observe gastric peristalsis just prior to emesis as the peristaltic waves try to overcome the obstruction.
  • Signs of dehydration include depressed fontanelles, dry mucous membranes, decreased tearing, poor skin turgor, and lethargy.
  • Due to the widespread early use of ultrasonography to aid in diagnosis, the classic signs of infantile hypertrophic pyloric stenosis are becoming less common. The mean age of presentation is getting significantly younger, and infants are not developing the physical signs or electrolyte abnormalities they were in the past.

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