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.

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Comparison

Side-by-side3 compared
Comparevs
Dimension
Pyloric Stenosis
Intussusception
Hirschsprung Disease
Pathophysiology & risk
  • Pyloric muscle hypertrophy then 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 then perforation
  • ★Fever + explosive diarrhea then enterocolitis
Complications
  • Aspiration
  • electrolyte imbalance
  • Bowel ischemia / necrosis
  • Enterocolitis (life-threatening)
Pathophysiology & risk

Pyloric Stenosis

  • Pyloric muscle hypertrophy then 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 then 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.

Component Topics

Hirschsprung DiseaseIntussusceptionPyloric Stenosis

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