A 4-week-old firstborn boy has projectile non-bilious vomiting after every feed and an olive-shaped epigastric mass. Blood gas shows hypochloraemic hypokalaemic metabolic alkalosis. What is the correct management?
Answer and explanation
Correct answer: D. Correct dehydration and electrolytes with saline and dextrose, then perform pyloromyotomy
- Step 1: The picture is hypertrophic pyloric stenosis, and persistent loss of gastric acid produces metabolic alkalosis with hypochloraemia and hypokalaemia.
- Step 2: Surgery is definitive but anaesthesia is unsafe until fluid, chloride, potassium and alkalosis are corrected, so resuscitation precedes pyloromyotomy.
Answer
Correct dehydration and electrolytes with saline and dextrose, then perform pyloromyotomy.
Why not the others: Operating first risks postoperative apnoea from alkalosis; oral rehydration and prokinetics cannot overcome the mechanical obstruction; medical therapy is a rarely used, prolonged alternative.
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