MEDizzy - A 2-week-old infant with a firm, ovoid, olive-shaped

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Gastrointestinal System

A 2-week-old infant with a firm, ovoid, olive-shaped palpable mass in the region of the pylorus would most likely have which one of the listed findings?

ExplanationA firm olive-shaped mass in the region of the pylorus in a newborn during the first couple of weeks of life is a characteristic physical finding of congenital hypertrophic pyloric stenosis. Infants with this congenital disorder present in the second or third week of life with symptoms of regurgitation and persistent severe projectile vomiting (“projectile” because it is more forceful than usual). Surgical splitting of the muscle in the stenotic region is curative. Choanal atresia should be suspected in a neonate with cyanosis that increases with feeding, but decreases with crying. Physical examination will find that a catheter can’t pass through nose as the choana is the normal opening between the nasal cavity and the nasopharynx. A “double bubble” sign seen with an x-ray is characteristic of duodenal atresia and is due to air in stomach and proximal duodenum. Duodenal atresia should be considered in a newborn with persistent bilious vomiting after feeding, or failure to pass meconium, or polyhydramnios during pregnancy. Failure to pass meconium soon after birth followed by constipation and possible abdominal distention are signs of congenital aganglionic megacolon (Hirschsprung disease), which is caused by failure of the neural crest cells to migrate all the way to the anus. This results in a portion of distal colon to lack ganglion cells and both Meissner submucosal and Auerbach myenteric plexuses and causes a functional obstruction and dilation proximal to the affected portion of colon.