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Failure of duodenal lumen recanalization
8%
9/116
Failure of neural crest cell migration into the rectum
3%
3/116
Hypertrophic muscularis externa
75%
87/116
Patent tract between the trachea and esophagus
4/116
Telescoping of the small bowel into the large bowel
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The patient in this vignette presents with non-bloody non-bilious vomiting after feeding suggestive of pyloric stenosis. This condition is caused by a hypertrophic muscularis externa layer in the pyloric sphincter leading to gastric outlet obstruction. Pyloric stenosis classically presents after 2-3 weeks of normal feeding with non-bilious vomiting after every feed. Children with pyloric stenosis can become severely malnourished and dehydrated and will constantly be hungry. A palpable epigastric olive-shaped mass is pathognomonic for the disorder. Pyloric stenosis is more common in firstborn males, is associated with macrolide use, and is treatable with surgery. Pyloric stenosis is caused by a congenitally hypertrophied muscularis externa in the pyloric sphincter which prevents the stomach from emptying its contents into the intestinal tract. Incorrect Answers: Answer 1: Failure of duodenal lumen recanalization is the underlying cause of duodenal atresia. This condition will present with bilious vomiting (in contrast to the non-bilious vomiting seen in pyloric stenosis) and a "double bubble" sign on abdominal radiography due to the enlarged stomach and duodenum. Answer 2: Failure of neural crest cell migration into the rectum is the underlying cause of Hirschsprung disease. This condition will present with bilious vomiting, failure to pass meconium after birth, and chronic constipation. Answer 4: A patent tract between the trachea and esophagus is characteristic of a tracheoesophageal fistula. This condition will present with increased oral secretions and feeding difficulties including gagging or choking with feeds. Answer 5: Telescoping of the small bowel into the large bowel is the underlying cause of intussusception. This condition will present with the abrupt onset of colicky abdominal pain, bilious emesis, and currant jelly stools. Bullet Summary: Pyloric stenosis is caused by a congenital hypertrophic pyloric sphincter which leads to non-bilious vomiting following feeds.
4.8
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