Ɓiɗɗo Ɓooyɗo (Green) Ɓooygol, Ɓooygol Projectile, e Ɓooygol Intussusception (Ɓoornugol 'Currant Jelly')¶

Nde wonnoo kosam ɓuuɓɗam, ɗam alaa ko tiiɗi (gastroesophageal reflux) ina waɗa e ko ɓuri 70 e nder teemedere sukaaɓe celluɓe caggal nde ɓe ñamli, mbaydiiji tati ceertuɗi e ɓuuɓri cukalel e ɓuuɓri reedu ko goonga e ɓuuɓri sukaaɓe ɗo leelgol hay waktuuji 2 haa 6 ina waawi addude nekrosis ɓalndu catastrophique, hypovolemic or(sholi)b lime-vert walla ɓaleejo-espinaas) ɓuuɓri saabi ɗum ko Malrotation intestinale avec Volvulus Midgut, (2) Ɓuuɓri "projectile" doole, ndi alaa ko woni e mum so wonaa biliyoŋ e nder cukalel ngel duuɓi 2 haa 8 saabi ɗum ko Stenosis Pylorique Hypertrophique (HPS), e (3) Ɗoon e ɗoon, ɓuuɓol cirƴam ngol ɓuuɓol ngol ɓuuɓnataa ɗo cukalel ngel duuɓi 3 haa 36 ɓuuɓnata koppi mum e ɓalndu mum, ngel wayla ɓuuɓol/leeltol hakkunde ɓuuɓol, ngel rewa e ƴiiƴam-e-muus ("jelly currant") ɓuuɓri Intuslic** saabaade **Isuslic

So tawii cukalel maa ina ɓuuɓna ndiyam ɓalejam walla danejam hay so laawol gootol, ina ɓuuɓna, ina ɓuuɓna, walla ina ɓuuɓna, ina jogii reedu tiiɗndu walla ina ɓuuɓna, walla ina woppa waɗde paɗe ɓuuɓɗe, noddu limoore emergency nokku maa (911 to leyɗeele dentuɗe Amerik e Kanadaa, 112 e nder Dental Orop fof, 999 e nder leydi Angalteer) walla ƴeewto regginorde men winndereyankoore nde limooje caɗtuɗe ɗoon e ɗoon. Ngam emergency feso, ƴeew cukalel toowngel nguleeki e ɓuuɓri ɓuuɓri. Rewrude e porotokol triage surgical sukaaɓe les ɗoo.

Waɗde ɗum jooni¶

1. Safru KALA lime-green jalboowo walla ladde-green ɓaleejo (bilious) ɓuuɓri e nder cukalel ko wayi no emergency opereeji baawɗi warde nguurndam (Midgut Volvulus) haa nde selli ko wonaa ɗuum : Tufnde reedu no woorunoo ko daneejo, laaɓɗo, walla boɗeejo ɓuuɓɗo (ummoraade e kolostrum, e ɓuuɓri kosam, walla e asid reedu). Bile ɓaleejo ina naata e nder ɓalndu e nder feccere ɗiɗmere e nder ɓalndu (Ampulla of Vater). So tawii bile ɓaleejo ina yalta e hunuko cukalel, ɓalndu nduu ina ɓuuɓtoo e ɓanndu les ɓuuɓri bile, ɓalndu tokoosru nduu fof ina waawi ɓuuɓde 360 degere e saraaji ƴiiƴam mum (superior mesenteric artery volvulus), fawde e gangrene ɓalndu timmundu e nder waktuuji 2 haa 6.
2. Ƴettu foto laaɓtuɗo e smartphone mo ɓuuɓri ndii (e dow lefol danewol/burp) e ɓuuɓri ndii, ngaddaa ɓuuɓri ndii softunde e nder saak Ziploc to Departemaa Emergency: Les fitirlaaji jalbooji e nder safrirde, hollude cafroowo cafrirɗo oo foto emerald/spinach vobilid co ("jelly currant") stool ina rewi e waktuuji leeltugol triage, ina addana neɗɗo waɗde konsultaasiyoŋ seppo ko yaawi.
3. WOPPIT denndaangal ñamri hunduko (NPO , alaa kosam ɗam, kosam ɗam, ndiyam, walla kosam elektorolit) ɗoon e ɗoon so aɗa yaha to Departemaa Emergency: So tawii ɓiɗɗo maa ina jogii ɓalndu ɓuuɓndu (volvulus), ɓalndu teleskop ( ).intussusception), walla ɓuuɓri reedu ( ).pyloric stenosis), waɗde ndiyam ɓurɗam heewde e reedu ina addana neɗɗo ɓuuɓde ɗoon e ɗoon, aspiraasiyoŋ e nder ƴiiƴam, ina leeltina anestesi kuuɓtodinɗo ngam seppo walla ustude henndu-enema.
4. Keɓde cukalel ngel ɓuuɓngel ina darii e bannge maɓɓe (Lateral Recovery Position) walla jogaade darnde tiiɗnde e dow koyngal maa e nder yah-ngartaa: Hoto meeɗ lelnude cukalel ngel ɓuuɓnataa walla ngel ɓuuɓnaaki caggal nde ngel ɓuuɓnata, ngel ɓuuɓna e dow ɓalndu mum ɗo asid walla bile reedu ɓuuɓɗo waawi foofde e nder ƴiiƴam.
5. Anndu "Silent Lethargy Trap" e ɓuuɓri: Hakkunde ɓuuɓri gonndi e ɓuuɓri (ko waɗata kala 15 haa 20 minit nde ɓuuɓri peristaltik ɓuuɓnata ɓalndu teleskop), cukalel gonngel e ɓuuɓri ina heewi yaltinde endorfinuuji gonɗi e nder ɓalndu mum, ina wonta ɓuuɓri, ina wonta gla diskete/somno**. Hoto meeɗ yejjitde oon gap deƴƴuɗo hojomaaji 15 ngam « cukalel ngel ina weltii e ɗaanaade », ko ɗum maande ɓuuɓri ƴiiƴam mesenterik e ɓuuɓri neurogenik.
6. Yah to Opitaal Sukaaɓe walla Departemaa Emergency Sukaaɓe keeriiɗo mo Ultrasound Sukaaɓe e Opereeji Sukaaɓe 24/7 : Ƴeewtaade e feewnude stenosis pylorique, intussusception (pneumatic/hydrostatic enema reduction), e ɓuuɓri hakkundeeri (Ladd procedure) ina ɗaɓɓi radiyoloji sukaaɓe e seernaaɓe ; yahde to nokku sukaaɓe ina hisna jolngo ambulance hakkunde opitaaluuji waktuuji 2.

Lekki pellital : ɓuuɓri cukalel e triage ɓuuɓri reedu ɓuuɓndi¶

Huutoro ndeeɗoo nate safaara ngam seerndude ɓuuɓri cukalel moƴƴel e caɗeele tati mawɗe ɗe sukaaɓe njiylotoo :

flowchart TD
    Start["Cukalel tokosel walla tokosel ngel ɓuuɓri doole, ɓuuɓri ɓaleeri, walla ɓuuɓri reedu wullaango"] --> ColorCheck{"1. Hol Nokkuure woni Vomit?"}
    ColorCheck -->|"LIME-VERT WALLA ESPINACH-VERT DAAR (Bilious)<br/>(Hay Episode gooto e nder cukalel)"| Volvulus["KATEGORI 1 ƁURI ƁURDE ƁURDE: SIUMAADE VOLVULUS ƁURƊO WOƊƊUDE<br/>1. Woppude ñamri ndii fof (NPO) -> Jogaade cukalel ngel e bannge<br/>2. Foto ɓuuɓri ɓaleeri -> Yah to ED sukaaɓe ƊOONI<br/>3. Ina ɗaɓɓi wuurtinde IV + GI toowɗo / Ultrasound & Ladd Ladd Opereeji"]
    ColorCheck -->|"KOƊƊO ƁURƊO / ƁURƊO / LAAƁƊO / ƁURƊO ƁURDE (Mo wonaa Bilious)"| PatternCheck{"2. Hol ko woni Pattern Clinical & Duuɓi Cukalel ngel?"}
    PatternCheck -->|"Duuɓi 2 haa 8 Yontereeji:<br/>Doole 'Projectile' Ɓoornugol Fiyde e nder Ɓoornugol Ɓaawo Ñaamde<br/>+ Ɓiɗɗo oo ina woya ɗoon e ɗoon ngam ñaamde kadi ('Ɓoornugol weelo')"| Pyloric["TUUMƊO ƁURI ƁURDE ƁURDE ƁURDE ƁURDE ƁURDE (HPS)<br/>1. Jokkude ñamri -> Yah to ED sukaaɓe Hannde<br/>2. Ƴeewto so tawii ndiyam ina ŋakki + Hipokloremik Hipokalemik Alkalosis Metabolik<br/>3. Ultrason ina hollita 'Olive' -> IV Saline/Potaasiyom FOTI ko adii Piloromiotomi"]
    PatternCheck -->|"Duuɓi Lebbi 3 haa Duuɓi 3:<br/>Wullagol Siklowol Ɓooyngol Kala 15-20 Min Pullol Koppi haa Koppi<br/>+ Pale/Letargic Hakkunde Ɓoggi +/- Ɓoggi 'Currant Jelly' Boɗeeji"| Intuss["TUUMƊO ILEOKOLIK ƁURƊO ƁURDE<br/>1. Jokkude ñamri (NPO) -> Paɗe fotooje -> Yah to ED sukaaɓe ƊOONI<br/>2. Ultrason hollirta ko 'Maande / Donut'<br/>3. Safreede tawa alaa taƴre e laawol Urgent Air walla Saline Contrast Enema Ustugol"]
    PatternCheck -->|"Kosam tokosam ɗam alaa ko tiiɗi caggal nde burpi,<br/>Ɓeydagol teddungal weltaare ('Spitter weltaare')"| Reflux["REFLUX GASTROESOFAGEAL FISIYOLOGIQUE BENIGN (GER)<br/>Waɗde 20-30 min caggal nde ñamri ndii ; pace butel ñamri; rewindaade sukaaɓe no woorunoo"]

Faandaare 1 : Matiriis ƴeewndo mawngo e 4 mborosaaji ɓuuɓɗi cukalel¶

Jibnaaɓe e infirmiyee en triage ina mbaawi seerndude reflux mo alaa ko bonnata e emergency tati seppooji ɗii e nder leƴƴanɗe 60 tawa ina ƴeewtoo Window Duuɓi, Nokkuure Ɓoornugol, Appetite Après Vomit, e Pattern Pain/Stool:

Faandaare 2 : Diwgol luggiɗngol 1, Ɓuuɓri Biliyoŋ (Haako-haako) e Volvulus Midgut (Waktuuji 6)¶

Hol ko waɗi kala cafroowo sukaaɓe e Leydi ina woppa kala ko ina doga ina doga to Departemaa Emergency so cukalel keso walla cukalel ngel ina ɓuuɓna ndiyam ɓalejam ?

1. Anatomi Malrotaasiyoŋ e Volvulus Midgut¶

E nder ƴellitaare ɓiɗɗo no haanirta nii (Aset 6 haa 10 e nder reedu), ɓalndu ɓiɗɗo oo ina yirloo 270 degere e dow waktu, ina jokkondiri e dow jokkere enɗam yaajnde (the mesentery) ummoraade e reedu toowndu nano ( ).Ligament of Treitz) haa les reedu ñaamo ( ).cecum). - E nder 1 e nder 500 jibinannde wuurnde (Intestinal Malrotation): Ngolɗoo yirlaade ina dartoo e feccere. E nokku ɗo ɓalndu nduu fof woni ɗoo e dow ŋoral jaajngal, dartingal, ɓalndu tokoosru nduu fof ina fawii e dow ŋoral caggal reedu nduu e dow kaayitaaji ɓuuɓɗi, ɓuuɓɗi, ina waɗi ƴiiƴam Mesenteric (SMA) e Vein ( ).SMV), tawi noon banngeeji fiɓnde ɗi ngonaa no woorunoo (Ladd's bands) taƴde dow duodenum. - Twist (Midgut Volvulus): Kala sahaa, ko ɓuri heewde e yontereeji 4 gadani nguurndam, ɓalndu tokoosru ndu alaa ankere ina waawi wirnude no towel ɓuuɓngel nii (360 to 720 degrees) sara oon ƴiiƴam ɓuuɓɗam. - Musibbaaji ɗiɗi e nder sahaa gooto: 1. Blokaas duodenal (Bilious Vomiting): Loop ɓuuɓɗo oo ina pinna duodenum udditirɗo les ɓuuɓri bile, ina doola bile heeñere ɓaleere jalboore ina hoota caggal e nder reedu, ina yalta e hunuko cukalel ngel. 2. Ɓuuɓri mesenterik (Total Midgut Necrosis): Ɓoornugol ngol ina ɓuuɓna Vein e Arterie Mesenteric Superieur ina rokka 100 e nder teemedere ɓalndu tokoosru (jejunum and ileum) e feccere ɓalndu mawndu. So wonaa untwisted e seppo (Ladd Procedure) e nder waktuuji 2 haa 6, ɓalndu tokoosru ɓiɗɗo oo fof maaya, ɗum addana ɗum septic shock fatal walla Syndrome de l’intestin court nguurndam mum fof ina ɗaɓɓi ñamri duumiindi e nder ƴiiƴam (TPN).

2. Ko waɗi Volvulus arano ina waawi foolde jibnaaɓe e safrooɓe (The Flat-Belly Trap)¶

• E nder waktuuji 1 haa 4 gadani e volvulus midgut, obstruction ina toowi e nder duodenum, ko ɗum waɗi reedu ɓiɗɗo oo ina heewi wonde ɓuuɓɗo no feewi, ina softi (ina ɓuuɓna), kadi ɓiɗɗo oo ina waawi yiyde ina weltii no feewi hakkunde ɓuuɓri ɓaleeri.
• Daɗndude reedu ɓuuɓndu, tiiɗndu walla ƴiiƴam ko fadde juutnde : Reedu tiiɗndu, ɓuuɓndu, ɓalndu boɗeeru/boɗeeru, takikardiya, e ƴiiƴam ina firta wonde ɓalndu nduu fuɗɗiima ɓuuɓde (maayde). Episode gooto e emesis bilious vert goonga e nder cukalel ina ɗaɓɓi yah-ngartaa ko yaawi.

Faandaare 3 : Diwgol luggiɗngol 2, Stenosis pilorik hipertrofik (HPS e Ɓoornugol Projektiil)¶

E nder 2 haa 3,5 e nder kala 1 000 cukalel, ko ɓuri heewde e mum en ko cukalel jibinannde hakkunde jonte 3 e 6 (ina ɓura heewde so tawii ina wondi e mborosaaji makroliid hono eritromisin walla azitromisin e nder yontereeji ɗiɗi gadani nguurndam), StenopersisHPS) ko ɓuuɓri mekanik yahrundi yeeso e cirƴam cirƴam to yaltirde reedu (the pyloric sphincter).

1. No anndirta stenosis pylorique projectile so wonaa e refluks no woorunoo walla e muñal formule¶

1. Eskalaasiyoŋ "Doole & Woɗɗude" Ko ɓuri Balɗe 3 haa 7:
2. Ina heewi fuɗɗoraade ko hedde yontereeji 3 ina nanndi e ɓuuɓri doole, caggal ɗuum ina yaawi ɓeydaade haa kala ñaamdu joofna e ɓuuɓri nanndundi e ɓuuɓri kosam ɗam danejam, ɗam ɓuuɓɗam, ɗam ɓuuɓɗam (waktuuji goɗɗi ina ɓuuɓna ɗum e "coffee ir.ma bile vert**) ɓuuɓoowo 30 haa 90 santimeeteer (1 haa 3 feet) ina rewi e koyɗe cukalel ngel.
3. Jikku "Vomiter weelo" kiiɗɗo:
4. Cukalel gonngel e mboros reedu walla ɓuuɓri ɓalndu (mo nanata ko ɓuuɓri, salii bottaari), cukalel gonngel e stenosis pylorique puɗɗoriiɗo ina jogii ngaandi e ɓalndu celluɗo no feewi, tawi ko heege tan sabu nguura waawaa rewde e damal reedu ɓuuɓngal. Ndeen ɓiɗɗo oo timminii ɓuuɓde projectile, ɓe roonda ladde e ɓanndu maa, ɓe ngulla e tikkere ngam ɓe ñamlee kadi.
5. "Onde Peristaltique Golf-Ball" Yi'eteende Caggal Nyaamdu:
6. So a udditii reedu ɓiɗɗo maa les lampa ɗoon e ɗoon caggal nde ɓe njari kosam (ko adii nde ɓe ɓuuɓtata), aɗa waawi heewde yiyde wave ɓuuɓɗo, ɓuuɓɗo nannduɗo e ballal golf ina ɓuuɓtoo les ɓalndu gila e ƴiye nano haa e reedu hakkundeeru ñaamo nde reedu nduu ɓuuɓtata e blocke.

2. Kuulal Hospitaal Teeŋtungal : Ko waɗi Stenosis Pyloric Ko Emergency Medical Resuscitation Ko adii nde Wonta Emergency Opereeji¶

Jibnaaɓe ina keewi haawnaade so doktoor oo wiyi: "Min njiytii Pyloric Stenosis e ultrasound e nder hojomaaji 10, kono min ƳETTAA ɓiɗɗo maa to suudu seppo fotde waktuuji 12 haa 24." Ko ɗum waɗi oon leelgol ina hisna nguurndam ɓiɗɗo maa: - Alkalosis Metabolik Hipokloremik, Hipokalemik: Kala nde ɓiɗɗo maa ɓuuɓtii asid reedu laaɓɗo (\(\text{HCl}\)), ɓanndu mum ina waasa Ion Hidrojen (\(\text{H}**^+\)), Kuloriid (\(\text{HCl}\)) keewɗo (\(\binndi{Na}^+\)), e ndiyam. Ngam jogaade ndiyam, ƴiiƴam ɓiɗɗo oo ina ɓuuɓna Potasiyom (\(\text{K}^+\)) tedduɗo, ina jogoo Bikarbonaat (\(\text{HCO}_3^-\)), ina wayla ƴiiƴam ɓiɗɗo oo alkali (Metabolic Alkalosis). - Risk apnee caggal anestesi: Sabu bikarbonaat ƴiiƴam toowɗo (\(\text{HCO}_3^- > 30\text{ mEq/L}\)) ina fooɗa nokku foofaango ɓalndu ɓiɗɗo oo ngam leeltinde foofaango (ngam jogaade asid $\text{CO}_by anestesi ina addana apnee centrale postopératoire tiiɗɗo (dartaade foofaango caggal nde opereeji mbaɗi) e aritmiiji ɓernde ummoraade e ŋakkeende potaasiyom. - Protocole Safe: Goomu sukaaɓe ina adii rokkude waktuuji 12 haa 24 e nder ƴiiƴam 0.9% Normal Saline + Dextrose + Potassium Chloride haa kuloriid serum woni \(> 100\text{ mEq/L}\), bikarbonaat woni \(< 28\text{ mEq/L}\), tawa cukalel ngel ina waɗa paɗe ɓuuɓɗe, ko ndeen tan waɗata 15 minit Laparoskopi Ramstedt piloromiyotomi gonɗo e ɓalndu nduu (sp e sukaaɓe ñamlooɓe no haanirta nii e nder waktuuji seppooji).

Faandaare 4 : Diwgol luggiɗngol 3, Ɓoornugol (Ɓoornugol teleskop e ɓuuɓri 'Jelly Currant')¶

Intussusception ko #1 sabaabu ɓuuɓri ɓalndu e nder sukaaɓe e sukaaɓe tokosɓe hakkunde lebbi 3 e duuɓi 3 (ko ɓuri heewde e mum en ko hakkunde lebbi 5 e 9). Ina waɗa so tawii feccere ɓadtiinde ɓalndu tokoosru (the ileum) ina folla ina ɓuuɓtoo e nder ɓalndu mawndu saraaji mum ( ).the cecum/colon) hono no teleskop pirat ɓuuɓɗo nii walla soklaaji ɓuuɓɗi ɓuuɓɗi e nder caggal.

1. Ko waɗi Intussusception ina waɗa caggal nde ɓuuɓri, ɓuuɓri reedu, walla ɓuuɓri ƴiiƴam¶

E nder 90 e nder teemedere (idiopathic ileocolic intussusception), ñawu foofaandu viral keso (adenovirus) walla gastroenteritis viral ina addana ɓuuɓri limfatik no woorunoo e nder ɓalndu ileum (ɓuuɓri Peyer) ɓuuɓde no ɓuuɓri ɓuuɓndi nii. Ɓoornugol rimre no woorunoo e ɓalndu (peristalsis) nannga oon limce ɓuuɓɗe (the lead point) e ɓuuɓnude ɓalndu tokoosru nduu haa e nder ɓalndu nduu, ɓuuɓna ƴiiƴam mum (mesentery) e nder junngo tiiɗngo e maggo.

2. Triade Clinique Classique (E ko waɗi aɗa fotaani ɗaminaade ɓuuɓri)¶

Defte janngirɗe ina njanngina triade classique Nafoore reedu kolik + Mass soseeji palpable + Stool "Currant Jelly" boɗeejo, kono ko famɗi fof 30 e nder teemedere cukalon ina njogii maandeeji tati ɗii fof so ɓe ngartii e Departemaa Emergency:

1. Maande 1 (ina woodi e 85-90%): Ɗaɗi gonɗi e wullaango "koppi-to-koppi" paroxysmal e nder hojomaaji 15 haa 20 kala:
2. Cukalel gonngel e fijde walla e ɗaanaade, ɗoon e ɗoon yaltina wullaango ɓuuɓngo, ɓuuɓngo, ɓuuɓngo, ɓuuɓngo, fottoo koppi ɗiɗi ɗii fof e dow reedu mum fotde hojomaaji 2 haa 5 no ɓuuɓri peristaltik ɓuuɓnirta ɓalndu teleskoop nii.
3. Ndeen ɓuuɓri ndii dartii, ɓiɗɗo oo dartii woyde ɗoon e ɗoon.
4. Maande 2 (Pitfall ɓurɗo bonde e ƴeewndo): Ɓooygol luggiɗngol caggal ɓuuɓri / Floppiness "nannduɗo e stroke":
5. E nder hojomaaji 15 haa 20 hakkunde ɓuuɓri ɓuuɓri, ƴiye mesenterik ɓuuɓɗe ina njaltina opioiduuji nder ɓalndu e ɓuuɓri ɓuuɓndi, baɗooji cukalel ngel limtaangol, gite gilaasi, ɓuuɓɗo, ɗaaniiɗo, walla ɓuuɓɗo haa laaɓi. E goonga, 10 haa 15 e nder teemedere sukaaɓe wonduɓe e intussusception ina tawee e ɓuuɓri luggiɗndi e mbayliigu hakkille tawa ina woodi bojji laaɓtuɗi, e fuɗɗoode ina nanndi e sepsis walla meningitis.
6. Maande 3 (Maande LAADE e ɓuuɓri ƴiiƴam) : "Jelly Currant" Stool:
7. No ƴiiƴam ɓalndu ndernderiiru nanngaa nduu ɓuuɓtortoo nii, ƴiiƴam ɗam waawataa yaltude tawa ƴiiƴam ɗam ina jokki e pompaade e nder ɓalndu nduu, ƴiiƴam ɗam ina woya ƴiiƴam ɗam ɓalejam jillondirɗam e ɓuuɓri goblet-cell tiiɗndi, ina waɗa ɓuuɓri nanndundi e jelly currant boɗeejo ɓaleejo walla raspbe.
8. KUULE TEŊKERE: "Jelly Currant" ɓuuɓri firti ko ɓuuɓri ɓalndu ina ɓuuɓna tawo ina ɓuuɓna ƴiiƴam. Yah to Pediatric ED e daawal gonngal e wullude goddol haa e ɓalndu + ɓuuɓri/ɓuuɓri taƴndi, waktuuji ko adii ɓuuɓri ƴiiƴam meeɗaa feeñde.

3. No safrooɓe peewnirta intussusception tawa alaa ko opereeji mbaɗi (The Air or Saline Enema)¶

So tawii aɗa addana ɓiɗɗo maa to nokku toppitiiɗo ko fayti e cellal sukaaɓe ko yaawi (e nder waktuuji 12 haa 24 gadani, hade mum ɓuuɓde ɓalndu) : - Ultrason ƴeewndo (100% Radiation-Free): Ƴettu hojomaaji 5, feeñnina "Maande Target" / "Maande Donut" / "Maande Bull's-Eye" (ringuuji gonɗi e nder ɓalndu) ɗi njiyataa e nder taƴre. - Ustugol Enema Kontrast Pneumatik (Henndu) walla Hidrostatik (Saline) mo wonaa seppo : E nder 85 haa 90 e nder teemedere, alaa ko seppo haani hay dara. E nder ardorde ultrasound walla fluoroscopie e sahaa goonga, radiyoloji sukaaɓe ina waɗa kateter softuɗo no feewi e nder reedu nduu, ina waɗa toɓɓere henndu (\(\le 120\text{ mmHg}\)) walla saline gulɗo mo no feewi ina ɓuuɓna ileum teleskop oo caggal e nder reedu nduu e nder hojomaaji 3. (Tesko: e nder 5 haa 10 e nder teemedere sukaaɓe, ɓalndu ina waawi rewde teleskop e nder waktuuji 24 haa 48 gadani ɗii tawa ko ɓuuɓri Peyer ina ɓuuɓna haa jooni, ɗum noon ƴeewto-ɗee no feewi caggal nde ɗi njalti, so tawii ko gartugol ɓuuɓri cirƴam)

Faandaare 5 : Sabaabuuji goɗɗi baawɗi bonnude nguurndam cukalel ngel, ko wayi no ɓuuɓri e wullaango (Incarcerated Inguinal Hernia, Testicular Torsion, e Cow's Milk Protein Enterocolitis / FPIES)¶

Kala nde cukalel walla cukalel tokosel ina wondi e woyde ɓuuɓnde e ɓuuɓde doole, safrooɓe sukaaɓe ina njuppa ɓuuɓri ndii haa timma ngam ƴeewde so tawii ko emergences anatomiques externes ɗiɗi e sindrome de shock alimentaire-protein sévère gooto ina nanndi e intuspy stecepric no intuspy

1. Hernia inguinal gonɗo e kasoo walla ɓuuɓɗo (Always Check the Diaper Crease)¶

E nder 1 haa 5 e nder teemedere cukalel timmungel e haa 10 haa 30 e nder teemedere cukalel ngel jibinaaka (laabi 8 ɓuri heewde e sukaaɓe worɓe, hay so tawii noon ina yiyee kadi e sukaaɓe rewɓe ɗo ƴiiƴam waawi ɓuuɓde e nder kanndaa Nuck), **hernia inguinal ina waɗa so loop unlip unlip an intestinalpatent processus vaginalis) e nder ɓuuɓri ɓalndu walla ɓuuɓri ɓalndu. - Ko Jibnaaɓe Yi'ata So Diaper Urtiima: - ɓuuɓri tiiɗndi, ɓuuɓndi, ndi ɓuuɓnataa e nder ɓuuɓri ɓalndu (walla bannge gooto e ɓuuɓri ɓalndu) ndi ɓuuɓnataa so ɓiɗɗo oo woppii woyde, ina heewi waylude boɗewol, ɓuuɓngol, walla ɓuuɓngol no feewi e memondiral. - Sabu loocol ɓalndu pinndingol ngol ina ɓuuɓtoo haa laaɓi e nder cirƴam ɗam, cukalel ngel ina heɓa wullagol paroksismal, ɓuuɓgol reedu, e ɓuuɓgol doole (ngol waylata ɓaleejo biliyoŋ). - Golle ɗoon e ɗoon: - WOTO MEƊƊI etaade ɓuuɓnude ɓuuɓri tiiɗndi, boɗeeri, walla ɓuuɓri gonndi e nder hoore maa to galle (risk of rupturing ischemic bowel or reducing dead bowel en masse). Yah to Departemaa Emergency Sukaaɓe ɗoon e ɗoon mbele doktoor sukaaɓe ina waawa waɗde ustaare junngo sedated (taxis) e nder waktuuji 6 nguurndam hade mum waɗde ɓuuɓri ɓalndu walla testikulaar.

2. Torsiyoŋ testikulaaji cukalel walla cukalel¶

E nder cukalon worɓe, ɓuuɓgol ƴiiƴam (testicular torsion) ina addana ɓuuɓri vagal tiiɗndi, ɓuuɓri doole, e wullaango ɗoon e ɗoon ɗo cukalel ngel fawi koyɗe mum dow, ina weeɓi majjude ko kolik walla intussusception so tawii diaper oo ina heddii e ɓuuɓde. - Ƴeewndogol ƴiiƴam ɗam (Mandatory Diaper-Off Scrotal Check): Waɗde sahaa kala ƴeewto-ɗee banngeeji ɗiɗi ɗii fof e kala sahaa nde cukalel ngel woyi walla ngel ɓuuɓtii. So tawii bannge gooto e ƴiiƴam ina ɓuuɓi, ina tiiɗi, ina riiwta toowɗo, walla ina ɓuuɓna-boɗeewa, yahdu e Departemaa Emergency ɗoon e ɗoon (salvage testiculaire ina ustoo no feewi caggal waktuuji 4 haa 6 iskemi).

3. Sindoron enterokolitis ɓuuɓɗo mo poroteyiin nguura addata (FPIES) vs. Obstruksiyoŋ seppo¶

Hol ko woni so tawii cukalel ngel lebbi 2 haa 9 fuɗɗiima ɓuuɓde ɓuuɓnde, ɓuuɓnde, ɓuuɓnde, ɓuuɓnde, waktuuji 1 haa 4 caggal nde ƴeewti ñaamdu kesu (ko ɓuri heewde ko ɓuuɓri nagge, soya, oat, cereeli maaro, egg, walla banaana) e yaawde wonta **hypogremic, pa-y, e - Akut FPIES: Ko ɓuuɓri gonndi e ɓalndu nduu, ndi alaa ko woni e mum so wonaa cellal IgE, ndi addanta ɓuuɓri ndiyam keewndi e nder ɓuuɓri ɓalndu (third-spacing), addanta 15 haa 20 e nder teemedere cukalel ngel ina tawee e ɓuuɓri hipovolemik luggiɗndi nanndundi e sepsis, intussusception, walla volvulus. - Njuɓɓudi Emergency: Hay so a sikkaani FPIES gila e ñaamdu kesu naatnundu waktuuji 2 ko adii, yah to Departemaa Emergency ɗoon e ɗoon. Akut FPIES ina ɗaɓɓi jaawɗo bolusuuji ndiyam lamɗam no woorunoo e nder ƴiiƴam (20 mL/kg) e ondansetron gonɗo e nder ƴiiƴam walla e nder hunuko (Zofran) ngam dartinde ɓuuɓri gonndi e sitokineeji e haɗde ɓuuɓri.

Doggol ƴeewndo galle : ŋakkeende ndiyam e cukalel e banngeeji boɗeeji shock¶

Kala nde cukalel ngel ɓuuɓtoo laabi keewɗi, ƴeewto ɗeeɗoo 5 Hydration & Perfusion Markers hade mum e sahaa nde ngel nawtee to safrirde too :

• Limtu paɗe ɓuuɓɗe e nder waktuuji 12 haa 24 cakkitiiɗi ɗii : Cukalel gonngel e ndiyam ngel les lebbi 6 ina foti waɗde ko famɗi fof paɗe ɓuuɓɗe 6 teeŋtuɗe e nder waktuuji 24 (ko famɗi fof paɗe ɓuuɓɗe 1 e nder waktuuji 4 haa 6 kala). Yahde ko ɓuri waktuuji 6 e paɗe joorɗe ƴiye (walla kiristaaluuji urate-dust brik-dust orange ɓaleejo/pink e nder paɗe ɗee) ina hollita ŋakkeende ndiyam no feewi.
• Ƴeewto Fontanelle yeeso ("Soft Spot" dow hoore): So a jogaama e dow deeƴre e nder jooɗorde tiiɗnde, nokku softuɗo mo mbaydi diamant woni dow hoore ɓiɗɗo oo ina foti nanndude e ɓuuɓri e softunde. Toɓɓere softeende luggiɗnde, ɓuuɓnde ina hollita ŋakkeende ɓuuɓri ndiyam hakkundeere haa tiiɗnde (so tawii noon fontanelle tiiɗɗo, ɓuuɓɗo ina hollita ɓeydagol nguleeki nder reedu/meningitis).
• Ƴeewto gonɗi, ɓuuɓri hunduko, e mbaydi gite: Doggondira e junngo laaɓngo e nder wuttudu ɓiɗɗo oo: ina foti nanndude e ɓuuɓri ɓuuɓndi. Ɗemngal yoorngal, ɓuuɓngal, ɓuuɓngal, bojji ɗi ngalaa gonɗi ndiyam, e gite ɓuuɓɗe, ɓuuɓɗe, ɓuuɓɗe ina kollita \(\ge 5\text{ haa }10\%\) ŋakkeende ndiyam.
• Test Cakaare & Periferik Kapilaar Refill (The 2-Second Sternum Press): Toɓɓu junngo maa no feewi e hakkunde ƴiyal ɓiɗɗo oo (sternum) walla toɓɓere mawnde fotde leƴƴanɗe 3 haa ɓalndu nduu ɓaleejo, caggal ɗuum yaltina : colour pink ina foti ɓuuɓde caggal e nder les leƴƴanɗe 2. Waktu refill leƴƴanɗe 3 walla ko ɓuri ɗum, walla jokkere enɗam, coofnde, ina hollita ɓuuɓri hipovolemik compensé.
• Ƴeewto no foofirta: Pooftooji jaawɗi, luggiɗɗi (Kussmaul respirations) ina kollita asidosis metabolik tiiɗɗo ummoraade e ŋakkeende ndiyam walla iskemi ɓalndu, tawi noon foofaango ɓuuɓngo, ngo heewaani yiyeede ina waawi waɗde e alkalosis metabolik tiiɗɗo (pyloric stenosis).

Naamne keewɗe naamneede¶

Hol ko seerndi ɓuuɓri oole e ɓuuɓri ɓaleeri (bilious) e nder ɓiɗɗo?¶

Ɓuuɓri ɓaleeri walla ɓuuɓri ɓuuɓri ummortoo ko e ɓuuɓri kosam no woorunoo, e kolostrum, walla e ndiyam reedu dow ɓuuɓri bile, ina heewi e refluks moƴƴo walla e ɓuuɓri reedu. Ɓoornugol lime-green, highlighter-green, walla ɓaleejo ladde ɓaleejo (bilious) ina waɗi bile heeñere ɓuuɓnde e nder ɓalndu les reedu e nder feccere ɗimmere ɓuuɓri. So tawii bile ɓaleejo ina yalta e hunuko cukalel, ɗum firti ko ɓalndu nduu ina udditaa e ɓanndu les ɓuuɓri bile, ko ɓuri bonde e Intestinal Malrotation with Midgut Volvulus, ɗo ɓalndu tokoosru nduu fof ina taaroo ƴiiƴam mum mawɗam, ina waawi maayde e nder waktuuji 2 haa 6. Kala ɓuuɓri ɓaleeri e nder cukalel ina ɗaɓɓi yahde ko yaawi to suudu safrirdu.

Hol no mbaawir mi anndude ko seerndi ɓuuɓri ɓiɗɗo no woorunoo e ɓuuɓri projectile ummoraade e stenosis pylorique ?¶

Refluks fisiyoloji no woorunoo ("tufde weltaare") ina waɗa tawa alaa ko bonnata e nder burp walla caggal mum, ina rutta no feewi e dow ŋoral walla e ɓalndu ɓiɗɗo oo, ɓiɗɗo oo ina heddoo e wellitaare, ina ɓeydoo teddungal no feewi. Stenosis pylorique hipertrophique ina heewi fuɗɗoraade hakkunde jonte 2 e 8, ina addana ɓiɗɗo oo ɓuuɓde, ɓuuɓde no feewi, ɗo ñamri ndii fof, kosam ɗam alaa biliyoŋ, ina ɓuuɓtoo e nder arc 30 haa 90 santimeeteer (1 haa 3 feet) ina woɗɗi ɓiɗɗo oo frantically ngam nyaamde kadi ("vomiter weelo"), ustude teddeendi, e ustude paɗe ɓuuɓɗe.

Hol ko waɗi cukalel gonngel e intussusception ina wayi no ina ɗaanii walla ina waɗa no haanirta nii fotde hojomaaji 15 hakkunde fittaandu ?¶

E nder intussusception, feccere ɓalndu wooturu ina ɓuuɓtoo e nder feccere woɗnde ndee no teleskop nii. Kala hojomaaji 15 haa 20, ɓuuɓol naftowol (peristalsis) ina ɓuuɓna ɓalndu ndernderiiru nduu e ƴiiƴam mum ɓuuɓɗam, ina addana ɗum ɓuuɓde ɓuuɓnde e nder hojomaaji 2 haa 5 ɗo cukalel ngel wullata, ngel fawa koppi ɗiɗi ɗii fof e ɓalndu mum. So ndeen ɓuuɓol peristaltik ɓuuɓtii, ɓuuɓol ngol ina joofna, ɓalndu ɓuuɓndu nduu ina yaltina tolnooji ɓuuɓɗi (opioids) e nder ɓalndu (endorphines) e signaale vagal autonome ɗe mbaɗata cukalel ngel ina wayi no ɓuuɓol, ɓuuɓngol, ɓuuɓngol, walla ɓuuɓngol haa ɓuuɓol garoowol ngol yettoo hojomaaji 15 caggal ɗuum.

Mbele cukalel gonngel e intussusception walla stenosis pylorique ina sokli sahaa kala opereeji mawɗi udditiiɗi reedu ?¶

Alaa. Ngam ileocolic intussusception nanngaa ko yaawi hade ɓalndu nduu ɓuuɓde, 85 haa 90 e nder teemedere sukaaɓe ina cella tawa alaa ko seerndi ɗum en hay dara e huutoraade Enema walla Saline Enema mo ultrasound walla radiyoo ardii e nder hojomaaji 5 e nder suudu radiyoloji, mo ɓuuɓnata ɓalndu nduu no feewi e nder nokku teleskop. Wonande stenosis pilorik hipertrofik, so ndiyam gonɗam e nder ƴiiƴam feewnii ŋakkere ndiyam e elektorolit e nder waktuuji 12 haa 24, seppooji ɗii mbaɗata ko piloromyotomi laparoskopi mo alaa ko bonnata, rewrude e taƴe tokoose 3 milimeeteer ; opereeji ɗii ina mbaɗa hojomaaji 15 haa 20, ko ɓuri heewde e sukaaɓe ɓee puɗɗotoo ko yarde kosam e nder waktuuji 4 haa 6, janngo mum en ngarta galleeji mum en.

Fuɗɗoode ƴeewtaama¶

• Fedde Ameriknaare toppitiinde ko fayti e cellal sukaaɓe (APSA) & Akademi Ameriknaajo ko faati e safaara sukaaɓe (AAP, Taƴre ko faati e seppooji): Laabi gollorɗi safaara ngam ƴeewtaade ɓuuɓri biliyoŋ e nder cukalel (Malrotation e Volvulus Midgut), paandaale wuurtinde stenosis pilorik hipertrofik, e ustude ɓuuɓri ileokolik.
• Koolaaɗo kuuɓal laamɗo ko faati e cellal sukaaɓe e cellal sukaaɓe (RCPCH) & Duɗal ngenndiwal toppitiingal cellal e toppitagol (NICE, Leydi Biritaan, Laabi NG1 & CG84): Rafi ɓuuɓri ɓalndu e banngeeji boɗeeji seppooji ngam ɓuuɓri ƴiiƴam e ɓuuɓri ƴiiƴam e nder sukaaɓe e sukaaɓe.
• Koolaaɗo kuuɓal Amerik to bannge radiyoloji (ACR): Laabi potɗi huutoreede ngam ɓuuɓnude sukaaɓe haa lebbi 3 (Seeriiji GI toowɗi ngam Volvulus vs. Ultrasound ngam stenosis pylorique e intussusception).
• Fedde Adunaare Cellal (WHO): Deftere Pocket toppitagol sukaaɓe e opitaal: Laabi ngam ƴellitde ñawuuji sukaaɓe keewɗi e reedu ɓuuɓndu.

Ardiiɓe jokkondirɓe¶

• Botulisme cukalel (sindrome ‘floppy bébé’), woyde leelnde, e ɓuuɓde njuumri
• Cukalel toowngel nguleeki e ɓuuɓri ɓuuɓri
• Prolonged childhood fever (5+ days), Kawasaki disease, and pediatric red flags
• Button battery and high-powered neodymium magnet ingestion in children
• Child ingested foreign object: coins, sharps, and airway vs. gut triage
• Limooje emergency e leydi