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TREATMENT

■ Discontinue ASA, NSAID, or alcohol use.

■ Test for presence of H. pyloriand treat with triple therapy if present (see

Table 11.1).

COMPLICATIONS

Ulcers or GI bleeding

Pyloric Stenosis

Pyloric stenosis is caused by an increase in the musculature of the pylorus. Seen

in about 1 in 1000 live births. More common in firstborn males. Seen between

2 and 8 weeks of life (median, 5 weeks).

SYMPTOMS

Projectile vomiting of nonbilious emesis, dehydration, hypochloremic, meta-

bolic alkalosis

DIFFERENTIAL

GERD or bowel obstruction

EXAM

Olive-sized mass in the subhepatic region

DIAGNOSIS

Ultrasound or via visualization of “string sign”on upper GI series

TREATMENT

Surgery for pylorotomy and IV-fluid resuscitation

Gastrinoma (Zollinger-Ellison Syndrome)

Gastrin-secreting neuroendocrine tumor; two-thirds are malignant

SYMPTOMS

■ Recurrent and intractable peptic ulcer disease

■ Diarrhea is common with ZES.

DIFFERENTIAL

PUD, GERD, gastritis

EXAM

Epigastric tenderness on palpation

DIAGNOSIS

■ Elevated serum gastrin level

■ Multiple ulcers in abnormal locations on endoscopy

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Gastric ulcers get worse

shortly after eating, and

duodenal ulcers get better.

Pyloric stenosis causes

nonbilious emesis, whereas

intestinal obstruction causes

biliary emesis.