recognition matrix comparison
Pediatric GI Emergencies: Pyloric Stenosis vs Intussusception vs Hirschsprung
Three infant GI emergencies all show up with vomiting or abnormal stool — but picking the wrong one changes your entire assessment focus. The NCLEX loves pairing a specific age with a hallmark finding, and mixing these up sends you straight to the wrong answer.
Comparison
Side-by-side3 compared
Comparevs
Dimension
Pyloric Stenosis
Intussusception
Hirschsprung Disease
Pathophysiology & risk
- Pyloric muscle hypertrophy → outlet block
- Firstborn males, 2–6 weeks old
- Bowel telescopes (ileocolic most common)
- Peak 6–36 months
- Absent distal ganglion cells (aganglionosis)
- Linked to Down syndrome
Signs & symptoms
- ★Projectile non-bilious vomiting
- Hungry/eager to refeed; olive-shaped RUQ mass
- ★Currant jelly stool (blood + mucus)
- Episodic colic, draws knees up; sausage mass
- ★Fails to pass meconium < 48 hrs
- Ribbon-like stool; chronic constipation
Diagnostics & labs
- US: thickened pylorus > 3 mm
- Hypochloremic metabolic alkalosis
- US: target / donut sign
- Air/contrast enema (dx + therapeutic)
- Rectal biopsy: no ganglion cells
- Contrast enema: transition zone
Nursing priorities
- Correct fluid/electrolytes BEFORE surgery
- NPO, IV hydration
- Air enema reduction first-line
- Watch recurrence 24–48 hr
- Bowel decompression, NPO
- Monitor for enterocolitis
Definitive treatment
- Pyloromyotomy (Ramstedt)
- Surgery if enema fails or perforation
- Pull-through (resect aganglionic segment)
Patient & family teaching
- Small frequent feeds post-op; good prognosis
- Return if recurrent pain or vomiting
- Ostomy care if staged repair
Red flags — escalate
- Severe dehydration, lethargy
- Bilious vomiting / peritonitis → perforation
- ★Fever + explosive diarrhea → enterocolitis
Complications
- Aspiration; electrolyte imbalance
- Bowel ischemia / necrosis
- Enterocolitis (life-threatening)
Pathophysiology & risk
Pyloric Stenosis
- Pyloric muscle hypertrophy → outlet block
- Firstborn males, 2–6 weeks old
Intussusception
- Bowel telescopes (ileocolic most common)
- Peak 6–36 months
Signs & symptoms
Pyloric Stenosis
- ★Projectile non-bilious vomiting
- Hungry/eager to refeed; olive-shaped RUQ mass
Intussusception
- ★Currant jelly stool (blood + mucus)
- Episodic colic, draws knees up; sausage mass
Diagnostics & labs
Pyloric Stenosis
- US: thickened pylorus > 3 mm
- Hypochloremic metabolic alkalosis
Intussusception
- US: target / donut sign
- Air/contrast enema (dx + therapeutic)
Nursing priorities
Pyloric Stenosis
- Correct fluid/electrolytes BEFORE surgery
- NPO, IV hydration
Intussusception
- Air enema reduction first-line
- Watch recurrence 24–48 hr
Definitive treatment
Pyloric Stenosis
- Pyloromyotomy (Ramstedt)
Intussusception
- Surgery if enema fails or perforation
Patient & family teaching
Pyloric Stenosis
- Small frequent feeds post-op; good prognosis
Intussusception
- Return if recurrent pain or vomiting
Red flags — escalate
Pyloric Stenosis
- Severe dehydration, lethargy
Intussusception
- Bilious vomiting / peritonitis → perforation
Complications
Pyloric Stenosis
- Aspiration; electrolyte imbalance
Intussusception
- Bowel ischemia / necrosis
★ marks the fact that sets a column apart.
Clinical Pearl
Olive mass + projectile vomit = pyloric; currant jelly stool = intussusception; no meconium at birth = Hirschsprung.
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