- “Congenital” is a misnomer as it is never present at birth
- It presents 4-6 weeks after birth with non-bilious vomiting
- Common in first male child
- Associated with “Erythromycin” use in early life.
- On examination, an “olive shaped” mass is felt on epigastrium, which is hypertrophied pylorus
- Direction of gastric peristalsis is: Left to right.
- IOC is USG; characteristic finding is length of pylorus ≥16 mm & thickness ≥4 mm
- Signs on USG:
- Target sign
- Antral nipple sign
- Cervix sign.
- Signs of barium meal (proximal to distal):
- Caterpillar sign, Shoulder sign, Beak sign, Teat sign
- String sign, Double/ Triple track sign, Diamond sign
- Mushroom sign.
- X-ray sign: “Single bubble” sign.
Electrolyte imbalance in CHPS:
- Electrolyte imbalance is the MC cause of death in CHPS
- MC electrolyte imbalance: Hypochloremic hypokalemic metabolic alkalosis with paradoxical aciduria
- Urine is initially alkaline, but gets acidic later due to aldosterone activity; so, paradoxical aciduria is a late feature
- All ions are depleted (H/ Cl/ Na/ K)
- Most important ion to be corrected: ??−
- Concentration of NS used in CHPS: 0.45%
- TOC is Ramstedt’s pyloromyotomy (Transverse incision → Splitting of pyloric muscle)
- If surgery is done without correcting electrolyte imbalance, it may lead to postoperative apnea due to loss of respiratory drive as ?+ ions are depleted.
- Medical management (not good): Atropine injection/ Balloon dilatation.
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