Answer to the last #DiagnosticDilemma
Answer: C. Hypochloremic, hypokalemic metabolic alkalosis

Infantile hypertrophic pyloric stenosis classically presents with worsening non-bilious projectile emesis and a palpable olive-shaped mass on abdominal examination. Prolonged vomiting and the resultant loss of gastric hydrochloric acid result in hypochloremia and metabolic alkalosis.

In an attempt to maintain acid-base balance, the cellular hydrogen/potassium pump releases hydrogen into the extracellular space. This outflux of hydrogen causes an influx of potassium, which reduces extracellular potassium levels and causes hypokalemia. So, overall there is hypochloremic, hypokalemic metabolic alkalosis.

The key step in management is rehydration with intravenous fluids, which often corrects the electrolyte disturbance. The initial diagnostic test of choice is an abdominal ultrasound, which allows for a measurement of the length and thickness of the wall muscle. After correction of electrolyte abnormalities, the standard treatment is surgical pyloromyotomy, which is a surgical procedure in which an incision is made in the longitudinal and circular muscles of the pylorus.

MAJOR TAKEAWAY: Infantile hypertrophic pyloric stenosis presents with progressive nonbilious projectile emesis and a palpable olive-shaped mass on physical examination. Prolonged vomiting and the resultant loss of gastric hydrochloric acid results in hypochloremic, hypokalemic metabolic alkalosis.

Source: https://pxmd.co/cjJ5n
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