A 3-month-old patient, experiencing projectile vomit for nearly 48 hours, was brought to a hospital. The vomitus was not bile stained. A small mass could be felt on the right costal margin. What is the most likely diagnosis? Hemigastrectomy Tracheoesophageal fistula Gastritis Hypertrophic pyloric stenosis
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The patient is a 3-month-old infant experiencing projectile vomiting for 48 hours. The vomit is not bile-stained, and a small mass is palpable in the right costal margin. Show more…
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Scenario/SummaryHistory:A 4-week-old has been vomiting repeatedly for the past several days. It is getting worse. Today it occurs immediately after nursing and is so forceful it shoots across the room! He appears ravenously hungry, and drinks vigorously, but immediately vomits again.Physical Exam:Infant has evidence of dehydration. On abdominal exam there is a small, firm, "lump" that can be felt in the upper abdomen.Labs/tests:An abdominal ultrasound shows thickening of the pylorusAssessment:Pyloric stenosisConsider the effect that repeated vomiting would have on the electrolytes of the body.He will need to receive IV fluids to correct his dehydration and electrolyte imbalances before heading to surgery to relieve the obstruction. Understanding that HCl is produced in the stomach and that he has been vomiting his stomach contents, predict the acid/base imbalance that repeated vomiting will cause.Predict the effect on blood chloride level from repeated vomiting?"Normal saline" is often used to treat dehydration. What does it mean for the saline to be "normal"?Research to discover signs or symptoms of dehydration. List 3.Explain how an alteration in respiratory rate can compensate for an acid- base imbalance. Please provide sources.
Adi S.
A 58-year-old woman has progressively worsening epigastric pain. Upper endoscopy showed a 4-mm duodenal ulcer; biopsy specimens revealed mild gastritis with no evidence of malignancy, but she had several episodes of vomiting which included frank blood. Histologic evaluation of the tissue showed infection with Gram-negative bacilli.
Sri K.
A week later, he develops vomiting and abdominal pain with a soft mass palpable at the surgical site. An incisional hernia, or protrusion of bowel content through a poorly healed incision site, can be a complication after abdominal surgery. Incisional hernias can compress bowel contents and cause an obstruction of the digestive tract causing bowel content to back-up. This would explain the vomiting seen in this patient. Vomiting can be classified by presence of blood (hematemesis) or bile (bilious). Bilious vomiting is caused by obstructions distal to the major duodenal papilla. 4. Consider mobility of retroperitoneal vs. intraperitoneal organs through hernia sites. Which part of the bowel is likely obstructed? A. Duodenum B. Cecum C. Ascending colon D. Ileum E. Stomach 5. Would you expect this patient to have bilious or non-bilious vomiting?
Madhur L.
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