True about CHPS is all except -

CHPS Hypertrophy of circular muscle fibers of pylorus with proximal extension into gastric antrum Increase incidence in the firstborn male child with M:F ratio 4:1. Inherited as a dominant polygenic trait. Manifestations: a. The usual age of presentation is 3-6 weeks of life with non-bilious projectile vomiting b. Palpable olive-shaped epigastric mass c. Nasogastric aspirate >10ml d. Positive family history e. Hypochloremic, hypokalemic metabolic alkalosis Upper gi imaging (barium study) Precaution: (1) Empty stomach via nasogastric tube before study (2) Remove contrast at end of the study Barium study features of chps a. Elongation and narrowing of the pyloric canal (2-4 cm length) b. Passing of small barium streak through pyloric canal is seen as a string of barium known as string sign. c. Crowding of muscle folds in pyloric canal known as double/triple track sign. d. Transient triangular tent-like cleft/niche in mid portion of the pyloric canal with the apex pointing inferiorly; e. Outpouching along lesser curvature due to disruption of antral peristalsis, known as pyloric teat/teat sign. f. The mass impression upon antrum with a streak of barium pointing toward the pyloric channel, known as beak sign/antral beaking. g. Indentation of the base of duodenal bulb known as umbrella/kirkling/ mushroom sign. h. Gastric hyperperistaltic waves are known as caterpillar sign. i.Gastric distension with fluid.