Pyloric Piper — Pyloric Stenosis: The Olive, the Fountain and the Hungry Baby
Projectile vomiting in a 3-to-6-week-old who is starving right after — feel for the olive
The fountain goes off after every feed, the olive sits under Piper's fingertips, and the baby cries for more.
Piper guards the stomach's exit. In pyloric stenosis the muscle at the stomach outlet thickens until formula cannot pass, and it shoots back out as projectile vomiting — forceful, non-bloody and non-bilious, typically appearing at 3 to 6 weeks of age. The classic exam finding is a small, firm, olive-shaped mass in the right upper abdomen, with visible stomach waves moving left to right. The cruel clue: the baby vomits, then is immediately hungry again. Every vomit loses stomach acid, so the baby develops low chloride, low potassium and metabolic alkalosis — the opposite pattern of most vomiting illnesses. Treatment is pyloromyotomy after fluids and electrolytes are corrected.
Read Pyloric Piper's full story →The story arc
The setup
A 4-week-old has begun vomiting forcefully after every feeding.
The turn
On exam, Piper feels a small olive-shaped mass in the right upper abdomen and sees waves ripple across the belly.
The crisis
Despite the vomiting, the baby screams to feed again — and the labs show an unusual alkalosis.
The save
After IV fluids and electrolyte correction, a quick pyloromyotomy opens the exit and the baby feeds peacefully.
NCLEX study section — Pyloric Stenosis: The Olive, the Fountain and the Hungry Baby
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pediatrics
Take this chapter into practice questions on the same topic.