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Hypertrophic Pyloric Stenosis (HPS) โ classic presentation:
- Age: 2โ8 weeks (peak at 3โ6 weeks)
- Gender: Males > females (4:1 ratio)
- Projectile, non-bilious vomiting (post-pyloric, so no bile)
- Hungry after vomiting (not ill-appearing)
- Olive-shaped mass palpable in right epigastrium (hypertrophied pylorus)
- Visible peristaltic waves (left to right)
Electrolyte imbalance:
Repeated vomiting of gastric acid (HCl) causes loss of Hโบ and Clโป:
\[\text{Loss of HCl} \Rightarrow \downarrow \text{Cl}^- \Rightarrow \uparrow \text{HCO}_3^- \Rightarrow \text{Metabolic Alkalosis}\]
Kidney compensates by retaining Hโบ and excreting Kโบ โ Hypokalemia
Result: Hypochloremic, hypokalemic metabolic alkalosis
Diagnosis: Ultrasound (pyloric muscle thickness \(\geq 4\,\text{mm}\), channel length \(\geq 16\,\text{mm}\))
Treatment: First correct electrolytes and dehydration, then Ramstedt pyloromyotomy (surgical โ curative).
Identify the cause-and-effect relationship: i. Sara's productivity at work has significantly decreased. ii. Sara has been experiencing frequent interruptions due to ongoing construction work near her office.
The most logical cause-and-effect relationship is that the construction work (cause) leads to interruptions, which then lead to decreased productivity (effect). The other options reverse the causality or deny a relationship.
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