Question

An abdominal mass is best demonstrated in congenital hypertrophic pyloric stenosis by:

• A. In palpation over the epigastrium
• B. In left hypochondriac region
• C. Right iliac fossa
• D. During feeding

Hint:

The olive-shaped pyloric mass is felt best when the baby is relaxed and feeding - the test feed.

Answer 1

The Correct Option is D

Step 1: Congenital (infantile) hypertrophic pyloric stenosis presents in infants with projectile non-bilious vomiting, persistent hunger, weight loss and dehydration due to hypertrophy of the pyloric muscle.
Step 2: The diagnostic clinical bedside manoeuvre is the TEST FEED. While the relaxed baby feeds from a bottle, the examiner watches and palpates the abdomen. This is when the mass is best demonstrated. Option (d), during feeding, is correct.
Step 3: During the test feed visible gastric peristalsis travels left to right across the upper abdomen, and the firm pyloric 'tumour', the size of an olive, becomes palpable in the right upper quadrant as the relaxed stomach empties.
Step 4: Palpation over the epigastrium (a), the left hypochondrium (b) or right iliac fossa (c) alone, without the relaxation and gastric filling provided by feeding, is far less reliable. So the mass is best demonstrated during feeding, and ultrasound confirms the thickened muscle.