What is the most characteristic of congenital hyperophic pyloric stenosis -

Ans. is 'b' i.e., The pyloric tumor is best felt during feeding Option (a) - HPS classically presents in a first born male child between 3 and 6 weeks of age. However, children outside this age range also are commonly seen, and the disease is not restricted to either males or first borne children. Option (d) - After vomitting the child has voracious appetite, that leads to a cycle of feeding and vomiting. Option (c) "Greater awareness of pyloric stenosis has led to earlier identification of patients with fewer instances of chronic malnutrition and severe dehydration" -Nelson I7/e Option (b) - The diagnosis of pyloric stenosis is usually made by palpation - of the typical olive shaped hard pyloric mass located in right upper quadrant. In healthy infants when palpation is difficult, feeding can help in the diagnosis. After feeding gastric peristalsis waves may be visible. After the infant vomits, the abdominal musculature is more relaxed and the mass is easier to palpate. Sedation can also be used to facilitate examination but is usually unnecessary. In cases of doubt ultrasound can confirm the diagnosis.