Rockstar moment

On my last night in the Pedi ED (Wednesday, I think), I had a Rockstar moment. And it all has to do with the ultrasound from above (from the net, this isn't the real ultrasound from the patient I took care of). What you're looking at is the ultrasounds of the stomach, that bulge is called Pyloric Stenosis. An idiopathic condition where the pylorus becomes enlarged and obstructs the stomach from emptying, which results in vomiting. Or projectile vomiting, which is what we're taught in med school and residency. This kid didn't have classic projectile vomiting after every feed. But, while I was examining him, there were some forceful perstaltic waves, which were easily palpable. Right time, right place, the kiddo had just taken some pedialyte before I saw him. And that "palpable olive" that is classically described wasn't really appreciated. (Although after my exam, he did have a nice forceful vomit). I was hoping that this kiddo would have simple gastro (the story wasn't the classical version), but it was just unusual enough that my gut (pardon the intended pun) felt the need to get the ultrasound and rule out pyloric stenosis. The Rockstar moment was sticking to my history and physical and writing down pyloric stenosis as my first differential, and then gastro. The real Rockstar feeling is knowing that taking a good history and performing a good physical examination helped this kid get the right diagnosis early on--he had perfectly normal lytes, not even enough time to develop the classic hypokalemic hypochloremic metabolic alkalosis...