Rosh Pediatrics Practice Exam

What symptom indicates an anatomic obstruction of the gastric outlet in a young child?

1. Bilious emesis

2. Bloody stools

3. Chronic cough

4. Palpable right upper quadrant mass

The correct answer is: Palpable right upper quadrant mass

The presence of a palpable right upper quadrant mass is a significant symptom that suggests an anatomic obstruction of the gastric outlet in a young child. This mass is often associated with conditions such as hypertrophic pyloric stenosis, where the pylorus (the opening from the stomach into the small intestine) becomes narrowed, causing obstruction. In cases of pyloric stenosis, the muscle thickens, resulting in a palpable "olive-like" mass in the right upper quadrant. This mass can be felt during an abdominal examination and is considered a classic finding for this condition. The obstruction leads to difficulty in passing food from the stomach, which can result in vomiting and dehydration but the tangible mass is a key indicator of the anatomical problem. Other symptoms, while potentially indicative of gastrointestinal issues, do not specifically confirm an anatomical obstruction of the gastric outlet. For example, bilious emesis may suggest various complications, including intestinal obstruction, but it does not point directly to a specific anatomical obstruction. Bloody stools often indicate conditions like intussusception or more severe gastroenteritis, while chronic cough is more associated with respiratory conditions and does not correlate with gastric outlet obstruction. Thus, the palpable right upper quadrant mass directly points to an anatomical issue that requires further investigation or intervention