Question

question 35 (mandatory) (2 points)
listen
a three - week old baby is seen in your office and is found to be distressed, and looking very thin. on questioning, the mother admits that the baby seems to be losing weight and that following feeding the baby cries a lot and then throws up the milk very forcefully. on examination you note the presence of peristaltic waves in the epigastrium, the presence of a hard lump in the right hypochondrium, and you move to one side just in time to avoid an episode of projectile vomiting. having reached a diagnosis you immediately refer the baby to the pediatrician. what is the most likely diagnosis from these above facts?
congenital pyloric stenosis
achalasia of the esophagus
zollínger - ellison syndrome
cystic fibrosis

Explanation:

1. Analyze each option:

• Congenital pyloric stenosis: Common in infants (2 - 8 weeks), presents with projectile vomiting after feeds, weight loss, peristaltic waves in epigastrium, and a hard lump (pyloric tumor) in right hypochondrium. This matches the baby's symptoms.
• Achalasia of the esophagus: Affects esophageal motility, causes difficulty swallowing, regurgitation, but not the specific pattern of projectile vomiting after feeds with the other signs here.
• Zollinger - Ellison syndrome: Causes gastric hypersecretion and ulcers, more common in adults, not typical in a 3 - week - old with this presentation.
• Cystic fibrosis: Primarily affects lungs and pancreas, presents with respiratory issues, meconium ileus in newborns, not the vomiting and abdominal signs described here.

1. Based on the symptoms (projectile vomiting after feeds, weight loss, peristaltic waves, hard lump in right hypochondrium) in a 3 - week - old, the most likely diagnosis is Congenital pyloric stenosis.

Answer:

A. Congenital pyloric stenosis