A nurse is caring for a male infant who has a palpable, sausage-shaped mass in the upper right quadrant and stools mixed with blood and mucus. The nurse should recognize that which of the following diagnoses is associated with these findings?
A.
Intussusception
B.
Tracheoesophageal fistula
C.
Hypertrophic pyloric stenosis
D.
Inguinal hernia
The Correct Answer and Explanation is:
The correct answer is A. Intussusception.
Intussusception is a condition in which one part of the intestine telescopes into an adjacent part, leading to obstruction and reduced blood flow to the affected segment. This is most common in infants, particularly those between 6 months and 3 years of age, and is a pediatric emergency that requires prompt intervention.
Key Findings and Symptoms:
- Palpable, Sausage-shaped Mass: One of the hallmark signs of intussusception is a sausage-shaped mass in the upper abdomen, typically the right upper quadrant. This mass is formed by the invaginated portion of the intestine.
- Stools Mixed with Blood and Mucus: This is often described as “currant jelly stools.” The blood and mucus in the stool occur because the telescoping portion of the intestine causes irritation, inflammation, and ischemia (reduced blood flow). As the blood vessels are compressed, it leads to bleeding into the lumen of the intestine, resulting in the blood and mucus mixture.
- Sudden Abdominal Pain: Infants with intussusception typically experience episodes of severe, colicky abdominal pain. The child may cry intensely, draw their knees to their chest, and appear very distressed. This pain can come and go as the intestine intermittently telescopes and partially relieves itself.
Other Choices:
- B. Tracheoesophageal Fistula: This is a congenital condition in which there is an abnormal connection between the trachea and the esophagus, causing feeding difficulties, coughing, and risk of aspiration, but it is not associated with a palpable abdominal mass or bloody stools.
- C. Hypertrophic Pyloric Stenosis: This involves thickening of the pyloric muscle, leading to projectile vomiting and visible peristalsis, but it does not cause bloody stools or a sausage-shaped mass.
- D. Inguinal Hernia: This occurs when tissue, like a part of the intestine, protrudes through a weak spot in the abdominal muscles. It can cause a bulge in the groin, but is not associated with bloody stools or a mass in the right upper quadrant.
In summary, the classic triad of a palpable, sausage-shaped mass, bloody stools, and episodes of abdominal pain strongly indicates intussusception, which is a medical emergency.