Intussusception (Telescoping Bowel) a cikin Jarirai da Yara: Ƙirar Ƙirji-zuwa Ƙirji da Ƙarfafan Jelly¶

Intussusception shine mafi yawan abin da ke haifar da matsananciyar ** toshewar hanji ** a cikin jarirai da yara a tsakanin watanni 3 da watanni 36**: gaggawar ciki mai barazana ga rayuwa wanda sashin hanji (kusan ko da yaushe tsakiyar ƙarshen hanji) yana zamewa tare da ninkewa a cikin maƙwabtan da ke kusa da shi, mai ɗaukar hoto mai kama da nasa. jijiyoyin jini da mesentery a cikin m zobe. Yayin da bangon hanji ya kumbura, jini mai jijiyar jini ya koma sama kuma jijiyoyin jijiya suna shakewa, suna haifar da yanayin yanayi mai ban tsoro na ** kwatsam, kururuwar paroxysmal mai ban sha'awa inda yaron ya ja gwiwoyi biyu tam a kirji kowane minti 15 zuwa 20 ***, musanya tare da lokaci na rashin jin daɗi, rashin jin daɗi, ko rashin jin daɗi. ta hanyar amai da jajayen duhu, gauraye gamsasshe "jelly currant" stools. Idan jariri ko ƙaramin yaro ya nuna tsawa a cikin keken keke kwatsam, ya ja gwiwoyi zuwa cikinsa, ya zama ruwan dare mai ban sha'awa ko da wahala a farka tsakanin sassan, amai koren bile, ko wuce jini a cikin diaper, kira yankin ku. lambobin gaggawa nan da nan. Yayin jiran sufuri, duba jagora mai alaƙa akan toshewar hanji, ƙwanƙwasa hernia, da volvulus, appendicitis da kuma dama ƙananan ciwon quadrant, kuma guba abinci, gastroenteritis, da dehydration.

Saboda bangon hanji a farkon hanji yana raye, ** sama da kashi 85 zuwa 90 cikin 100 na yaran da ake yi musu magani da sauri a asibiti tare da ilimin rediyo na yara suna iya tura hanjin su a hankali a hankali a cikin mintuna ta amfani da ** Ultrasound- ko fluoroscopy - jagorar pneumatic (iska) ko aikin hydrostatic (saline) gaba ɗaya. Sabanin haka, jira a gida don "currant jelly stool" ya bayyana (lalacewar alamar mucosal necrosis) yana ba da damar hanjin da aka shaƙe don ya lalace, yana haifar da mummunan peritonitis da damuwa.

Yi wannan yanzu¶

1. Je zuwa sashin gaggawa na asibiti mafi kusa ko kuma a kira lambar gaggawa ta gida. Kira 911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a Burtaniya, 000 a Ostiraliya, ko tuntubi kundin adireshi na mu. lambobin gaggawa. Idan zai yiwu, je kai tsaye zuwa ** Asibitin Yara ko asibiti tare da duban dan tayi na yara na sa'o'i 24 da ƙarfin radiyon enema**, ko kiran motar asibiti nan da nan idan yaron yana da rauni, kodadde, floppy, ko amai koren ruwa.
2. Kiyaye jarirai ko yaro da baki da baki (NPO: NO madara, madara, madara, nono, ruwa, Pedialyte, ko abinci mai ƙarfi). An toshe hanjin yaron gaba ɗaya kuma yana iya buƙatar rage yawan iskar iska/salin enema nan take a ƙarƙashin lalata ko tiyatar gaggawa a ƙarƙashin maganin sa barci. Bayar da ruwa ko abinci a cikin cikin da ya toshe yana haifar da amai, yana karkatar da hanji sama da toshe, kuma yana ƙara haɗarin buri na huhu.
3. **KADA KA ba da magungunan zafi, magungunan tashin zuciya, magungunan zawo (loperamide/bismuth), ko gida enemas/laxatives. nama na hanji.
4. Lokacin lokutan kururuwa akan wayar ku kuma bayyana tsarin "On-Off Switch" zuwa ma'aikacin jinya. Ba kamar colic na yau da kullun ko ciwon kunne ba inda jariri ke kuka akai-akai na tsawon sa'o'i, rashin jin daɗi yana biye da raƙuman ruwa na hanji (** peristalsis**) na hanji: yaron yana tafiya daga wasa ko barci zuwa ** bugun kirji zuwa bugun kirji zuwa bugun kirji. zuwa 5mins**, sannan ta daina kukan nan take suka fara farilla, gumi, gajiye har na tsawon mintuna 10 zuwa 30** kafin igiyar ruwa ta taso.
5. Ajiye diaper na baya-bayan nan a cikin jakar filastik sannan a kawo shi tare da ku zuwa dakin gaggawa. Ko da stool bai riga ya yi kama da jinin ja mai haske ba ko "currant jelly," har zuwa kashi 70 cikin 100 na diapers a cikin intussusception gwajin tabbatacce ga ** microscopic occult blood (guaiac positive)** daga farkon venous likitin likitan gaggawa.
6. ** Gargadi tawagar gaggawa nan da nan idan yaron yana barci ba tare da sabani ba, floppy, ko kallo babu komai ("Lethargic Intussusception").** A cikin har zuwa ** 10 zuwa 20 bisa dari na jarirai **, endogenous opioid-kamar peptides da cytokines wanda gut ɗin ischemic ya fitar yana haifar da * * alamun rashin ƙarfi na jijiyoyin jiki, damuwa da kumburin ciki. ko stools na jini ya bayyana, akai-akai suna jagorantar likitocin asibiti su yi kuskuren tantance jaririn yana da ciwon sankarau, sepsis, ciwon bayan-ictal, ko shigar da kwayoyi na bazata sai dai idan an yi duban dan tayi na ciki.

Bishiyar yanke shawara: kimanta kururuwar jariri na cyclic, lethargy, amai mai ɗimbin yawa, da rashin fahimta.¶

flowchart TD
    Start["Jariri ko Yaro (Musamman Mai watanni 3 zuwa 36) Tare da Ƙwararrun kururuwa, Amai, Ragewa, ko Kwanciyar Jini"] --> GreenVomit{"Shin yaron yana amai mai haske koren koren bile (Bilious Vomiting), KO yana nuna tsayayyen ciki ko gigita?"}

    GreenVomit -->|"Ee: RASHIN TSAYI / KYAUTA KO NECROTIC INTUSSUSCEPTION"| Emergency["GAGGAWA MAI BARAZANAR RAYUWA: Kira 911/112/999 Nan da nan, Tsayayyen NPO, Farfaɗowar Ruwan Ruwa na IV & Tiyatar Yara"]

    GreenVomit -->|"NO: Duba Paroxysmal Screaming & Lethargy Pattern"| PatternCheck{"Shin yaron yana da hare-haren kururuwa na mintuna 2-5 na keke-da-keke yana jan gwiwoyi zuwa kirji kowane minti 15-30, rashin jin dadi/kumburi da ba a bayyana ba tsakanin hare-hare, tarin ciki na gefen dama, KO jini/laka a cikin kwanji?"}

    PatternCheck -->|"Ee ga kowace alamar: SHAHUWAR HANKALI"| Ultrasound["Matsakaicin Sashin Gaggawa na Asibiti: Madaidaicin NPO, Ajiye Diaper, Ciki na Gaggawa Nan take (Nemi Alamar Target / Bull's-Eye Sign)"]

    PatternCheck -->|"A'a: Ci gaba da kuka > Sa'o'i 3 a cikin jariri mai kyau < watanni 4, faɗakarwa ta al'ada, stool na al'ada, babu amai"| OtherCheck["Yi kimantawa don ciwon ciki na jarirai, yawon shakatawa na gashi, abrasion na Corneal, Otitis Media, ko Inguinal Hernia (Koyaushe cire diaper don duba ƙwanƙwasa.)"]

    Ultrasound --> Reduction["Tabbatar da Intussusception ba tare da Perforation ko Peritonitis: IV Fluid Bolus + Radiologic Pneumatic (Air) ko Hydrostatic (Saline) Ragewar Enema (85-90% Nasara Ba tare da tiyata ba)"]

Pathophysiology: yadda hanji telescopes da kuma dalilin da ya sa ya shake nasa jini¶

Ciwon ciki yana faruwa ne lokacin da wani yanki na kusa na gastrointestinal tract (wanda ake kira intussusceptum) ya kama shi ta hanyar igiyar hanji (peristalsis) kuma ya ci gaba a cikin lumen na kusa da sashin hanji (wanda ake kira ** intussuscipiens **).

ANATOMY OF ILEOCOLIC INTUSSUSCEPTION (90% OF ALL PEDIATRIC CASES)

   Proximal Small Bowel                          Distal Large Bowel
   (Terminal Ileum)                              (Ascending Colon)
   "THE INTUSSUSCEPTUM"                          "THE INTUSSUSCIPIENS"
   (Invaginates Inside)                          (Outer Receiving Sleeve)
            |                                             |
            v                                             v
   ====================\                    +===========================
                        \                   |  ===================
    Normal Lumen  --->   \==================|=>  TELESCOPED APEX  ===>
                        /  [Trapped Mesentery|   ("Lead Point": Swollen
   ====================/    & Blood Vessels] |    Peyer's Patch Lymph)
                                            +===========================
                                                          |
   CROSS-SECTION ON ULTRASOUND:                           v
        ( ( (  O  ) ) )                   1. Venous & Lymphatic Compression
   "TARGET SIGN" or "DOUGHNUT SIGN"       2. Bowel Wall Edema & Mucus Outpouring
   (Concentric alternating rings of       3. Arterial Strangulation & Mucosal Sloughing
    outer & inner bowel walls)               ("Currant Jelly" Blood + Mucus Stool)
                                          4. Transmural Necrosis & Perforation (24-72 hrs)

1. Me yasa jarirai 'yan watanni 3 zuwa 36 ke samun "Idiopathic" Ileocolic Intussusception (90% na lokuta)¶

A cikin ** kashi 90 cikin 100 na lokuta da ke faruwa tsakanin ** watanni 3 da shekaru 3** (tare da mafi girman abin da ya faru tsakanin watanni 5 da 9 na shekaru**), ana yin amfani da telescoping a ileocecal bawul inda kunkuntar tasha ileum ta haɗu da faffadan cecum da hawan hanji (** ileocolic intussusception **). - Maganin Kwayoyin cuta na "Peyer's Patch" Yana haifar da: Me yasa lafiyayyen ɗan wata 7 ke yin na'urar hangen nesa ba zato ba tsammani hanjinsu? Katangar tashar tasha na jarirai tana cike da faci na ƙwayoyin lymphoid na mucosal mai suna Peyer's patches **. Jim kadan bayn kamuwa da cutar *Viral babba na nuashi (adenovirus)** ko ** kwayar cutar ciwon ciki (gastroenteritis)**, ko kuma lokaci-lokaci a cikin kwanaki 1 zuwa 7 bayan kashi na farko ko a biyu na maganinrotavirus na baka, wadannan facin Peyer suna kumbura cikin bangon hanji don yakar cuta - Yadda kumburin kumburin lymph ke aiki a matsayin "Maganin Jagoranci": Raƙuman raƙuman ruwa na jarirai suna kuskuren fitowar, kumbura Peyer's patch don dunƙulen abinci kuma yayi ƙoƙarin tura shi gaba zuwa sashin narkewar abinci, yana jan duk bangon tashar tashar tare da shi daidai ta cikin bawul ɗin gidan.

2. Lokacin da gaskiya "Pathologic Lead Point" shine mai laifi (Children < 3 months or > 3 zuwa 5 shekaru)¶

Lokacin da intussusception ya faru ** a waje *** taga na zamani na watanni 3 zuwa 36 (musamman a cikin yara ** sama da shekaru 3 zuwa 5 *** ko ** ƙasa da watanni 3 ), ko kuma lokacin da ya sake maimaita sau da yawa, likitocin asibiti suna neman tsarin Pathologic Lead Point (PLP) yana jan hanji: - Meckel's diverticulum (madaidaicin tsarin jagora na #1 a cikin yara, fitar da ƙananan hanji) - ** Henoch-Schonlein Purpura (IgA Vasculitis) yana haifar da hematoma na submucosal a cikin ƙananan bangon hanji (yawanci * ileo-ileal * intussusception; duba Henoch-Schonlein purpura da IgA vasculitis), - ** polyps na hanji *** (yanayin yara ko ciwon Peutz-Jeghers), - ** lymphoma na hanji (Burkitt lymphoma)** a cikin yara sama da shekaru 5 zuwa 6, - Cystic fibrosis (kauri, mai kauri meconium/najasa matosai a cikin m ileum), ko ** hanji kwafi cysts**.

3. 4-mataki na jijiyoyin bugun gini strangulation cascade¶

Da zarar hanji na ciki (intussusceptum) ya ja a cikin hannun waje na waje (intussuscipiens), takardar jininsa mai siffar fan (** mesentery*) ana jan shi a ninke sosai tsakanin bangon hanji biyu: 1. Mataki na 1-Harkokin Lymphatic da Venous (Sa'o'i 1 zuwa 12): Domin veins da lymphatics suna da sirara, bango mara ƙarfi, ana matse su da farko. Jinin jini ba zai iya tserewa daga hanji mai na'urar hangen nesa ba, yana haifar da kumburi mai yawa da kumburi (** edema**) wanda ke kulle na'urar hangen nesa ta yadda ba zai iya zamewa da kanta ba. 2. Mataki na 2- Fitowar Ciwon Kwayoyin Kwayoyin Goblet + Ciwon Jini ("Currant Jelly"): Kamar yadda hawan jini ya karu, ƙwayoyin jijiyoyi a cikin rufin hanji mai shaƙatawa suna zubar da ƙura mai ƙyalƙyali yayin da ƙananan mucosal capillaries suka fashe kuma suna zubar da jini a cikin lumen. A hade tare da fitar da duburar, wannan duhu ja jajayen jini da gelatinous gamsai ya zama classic ** "currant jelly" stool **. 3. Mataki na 3 - Arterial Ischemia & Mucosal Necrosis (Sa'o'i 12 zuwa 36): Kumburi yana tashi sama da hawan jini, yana yanke sabon iskar oxygen zuwa bangon hanji. 4. Mataki na 4-Transmural Gangrene, Perforation, & Septic Shock (Sa'o'i 24 zuwa 72): Mataccen bangon hanji ya fashe, yana zubar da kwayoyin cuta na fecal a cikin rami na ciki (peritonitis), yana haifar da hypovolemic da damuwa mai tsauri.

Gane intussusception vs. gastroenteritis, jarirai colic, da sankarau¶

Domin ciwon intussusception yakan biyo bayan kamuwa da ciwon sanyi ko ciwon ciki kuma yana farawa da kukan lokaci-lokaci da amai kafin kowane jini ya bayyana a cikin stool, yana daya daga cikin abubuwan gaggawa da aka fi sani da su a likitan yara.

Teburin kwatanta na asibiti: Intussusception vs. Viral Gastroenteritis vs. Infantile Colic vs. Incarcerated Hernia¶

Tarkon "Lethargic / Encephalopathic Jarirai" (Me ya sa intussusception ke kwaikwayon Meningitis ko fiye)¶

Ɗaya daga cikin mahimman lu'u-lu'u na asibiti a cikin maganin gaggawa na yara shine cewa ** har zuwa kashi 10 zuwa 20 na jarirai da ke da ciwon ciki suna tare da "Rashin Raɗaɗi ko Ƙwararrun Ƙwararru" - Lokacin da hanjin jariri ya zama ischemic, hanji yana sakin babban ambaliya na **endogenous endorphins (opioid peptides) da cytokines masu kumburi ** zuwa cikin jini. - A cikin jariri mai watanni 5 zuwa 10, waɗannan opioids na endogenous suna aiki kai tsaye a kan kwakwalwa kamar kashi na morphine: jaririn ya isa dakin gaggawa ** ratsewa (hypotonic), kodadde, maras nauyi (da wuya a farka), tare da ɗimbin ƙima ko sluggish ɗalibi da numfashi mara hankali ***, wani lokacin kafin wani lamari na bayyanannen kukan jini ko kuka. - Likitoci akai-akai suna yin huda lumbar (taps na kashin baya) don waɗanda ake zargi da cutar sankarau, yin odar shugaban CT don bincikar ciwon kai, ko kuma ba da naloxone don zargin guba na opioid kafin sanin cewa jaririn yana da hanjin na'urar hangen nesa. Kowane jarirai da ke fama da tsananin gajiya ba tare da fayyace ba, yanayin yanayin tunani, ko pallor kwatsam ya kamata ya sami duban ciki na gado na mintuna 2.

Binciken asibiti: duban dan tayi "Alamar Target" (98% zuwa 100% daidaito)¶

Lokacin da kuka isa sashin gaggawa, gwajin gwajin ma'auni na gwal don hana intussusception yana da sauri, mara zafi, mara radiyo ** Ciki Ultrasound ***:

ULTRASOUND APPEARANCE OF INTUSSUSCEPTION (SENSITIVITY 98% TO 100%)

1. TRANSVERSE VIEW (Cross-Section):        2. LONGITUDINAL VIEW (Side Profile):
   "THE TARGET SIGN" / "BULL'S-EYE"           "THE PSEUDOKIDNEY SIGN"
   or "DOUGHNUT SIGN"                         or "SANDWICH SIGN"

          . - = = = - .                        +-----------------------------+
      . '   . - = - .   ' .                    | Outer Bowel Wall (Hypoechoic|
    /     /   . - .   \     \                  +-----------------------------+
   |     |   | (O) |   |     |                 | Echogenic Mesenteric Fat    |
    \     \   ' - '   /     /                  | & Trapped Blood Vessels     |
      . '   ' - _ - '   ' .                    +-----------------------------+
          ' - _ _ _ - '                        | Inner Invaginated Bowel     |
   (Diameter > 2.5 to 3.0 cm;                  +-----------------------------+
    Concentric alternating rings               (Layered tubular appearance
    of edematous bowel walls &                  resembling a kidney in the
    bright central mesenteric fat)              right upper abdomen)

• Me yasa filayen X-ray na ciki ba su isa ba: X-ray na ciki a sarari yana al'ada har zuwa kashi 25 zuwa 50** na lokuta masu saurin kamuwa da cutar. Ana ba da umarnin hasken X-ray da farko idan likita ya yi zargin ** iskar intraperitoneal kyauta (perforation) ** kafin yunƙurin rage enema.
• ** Me duban dan tayi ya gaya wa likitan rediyo da likitan fiɗa:**
• Tabbatar da alamar Target / Bull's- Eye (yawanci > 2.5 cm a cikin diamita na waje a cikin dama na ciki, idan aka kwatanta da < 1.5 cm a cikin ƙananan ƙananan hanji-zuwa-ƙaramin-hanji intussusceptions wanda ke warwarewa ba tare da bata lokaci ba).
• Dubawa *Launi Doppler jini na gudana *** a cikin bangon hanji mai na'urar hangen nesa kuma yana neman ** ruwa mai kama tsakanin zoben ko ruwan peritoneal kyauta.

Mahimmin jiyya na asibiti: Rashin tiyata na Pneumatic ko Ragewar Enema Hydrostatic¶

Kafin duk wani yunƙurin ragewa ya fara, ƙungiyar gaggawa ta sanya layin intravenous (IV), zana dakunan gwaje-gwaje na asali, suna ba da ** ruwa mai isotonic na jini (bolus).20 mL/kg na 0.9% Normal Saline or Lactated Ringer's)** don gyara rashin ruwa na sarari na uku, yana narkar da ciki tare da bututun hanci idan yaron yana amai, kuma yana faɗakar da ** ƙungiyar likitocin yara *** don tsayawa.

1. Bincika 3 cikakken contraindications zuwa rage enema¶

Dole ne a yi enema na rediyologic KADA idan akwai ɗaya daga cikin waɗannan alamun guda uku (waɗannan yaran suna tafiya ** kai tsaye zuwa ɗakin tiyata don tiyatar laparotomy **): 1. Pneumoperitoneum (Yancin iska a cikin ciki akan X-ray): Ya tabbatar da hanji ya riga ya huda. 2. Clinical Peritonitis: M, mai kama da allo, mai taushin ciki mai daɗi wanda ke nuni da mataccen hanji. 3. Rashin ƙarfi Septic ko Hypovolemic Shock wanda baya daidaitawa da sauri tare da farfaɗowar ruwan ciki na farko.

2. Yadda Ragewar Enema ba na tiyata ba (85% zuwa 90% na nasara)¶

Idan babu perforation ko peritonitis, likitan gidan rediyo na yara yana yin maganin warkewa ** Ragewar Enema Ileocolic ** a cikin fluoroscopy ko dakin duban dan tayi: - Ana sanya catheter mai laushi a hankali a cikin duburar yaron kuma ana haɗa gindin tare don ƙirƙirar hatimi mai laushi. - Hanyar A - Ciwon huhu (Air) Enema a ƙarƙashin Fluoroscopy: ** An tsara iskar likita a hankali a cikin hanji yayin da likitan rediyo ke kallo akan ƙananan ƙwayoyin X-ray fluoroscopy, baya barin matsa lamba na intracolonic ya wuce ** 80 zuwa 120 mmHg . Matashin iska yana turawa na'urar na'urar hangen nesa a hankali ta baya ta hanyar jujjuyawar hanji da hawan sama har sai ya tashi ta hanyar bawul din gidanocecal zuwa cikin tasha ileum (tabbatar ta hanyar ganin reflux iska cikin yardar kaina cikin ƙananan hanji). - ** Hanyar B - Hydrostatic (Dumi Saline ko Ruwa-Soluble Contrast) Enema karkashin duban dan tayi: Dumi al'ada Saline sun rataye a wani tsawo na ** 3 ƙafa (90 zuwa 100 cm) sama da tebur gudãna a hankali a cikin mallaka a karkashin m real-lokaci duban dan tayi na gani (sifili radiation) har sai da manufa taro gaba daya bayyana da kuma Saline rataye a cikin bawul ilese free ta hanyar da bawul gida sharuddan. - ** Idan ƙoƙari na farko yana motsa hanji kawai?

3. Lokacin da ake buƙatar rage aikin tiyata (Laparoscopy ko Laparotomy) (10% zuwa 15% na lokuta)¶

Idan an hana raguwar enema na rediyologic ko kuma ba zai iya tura hanji gaba ɗaya ta hanyar bawul ɗin gidaocecal ba, likitan yara ya ɗauki yaron zuwa ɗakin aiki: - ** Ragewar Hannu (Tsarin Cope):** Ta hanyar ƙaramin ɗan ƙaramin ɗan ƙaramin dama na dama ko laparoscope, likitan fiɗa a hankali ** yana matsawa (“madara”) kololuwar intussusception a baya daga waje (ba zai taɓa jan ƙafar kusa ba, wanda zai tsaga hanji mara ƙarfi). - ** Gyaran hanji:** Idan aka gano hanjin na'urar hangen nesa yana da gangrenous/necrotic, perforated, ko lalacewa ta hanyar sigar tsarin gubar ƙwayar cuta (kamar Meckel's diverticulum ko polyp), likitan fiɗa ya cire ɓangaren da ya lalace ya sake haɗa ƙarshen lafiyayyen.

Lissafin tantancewar gefen gado na iyaye da ma'aikatan lafiya: kimanta rashin ruwa, turawa, da alamun ciki¶

Yayin da ake jigilar jariri ko jariri da ake zargi da kamuwa da cutar zuwa sashen gaggawa na asibiti, ma'aikatan lafiya da iyaye su kula da yanayin yanayin jinin yaron da ci gaban ciki ba tare da dannawa a ciki ba:

• Duba Lokacin Ciki Capillary da Perfusion Skin: A hankali danna tsakiyar ƙashin ƙirjin yaro (sternum) ko goshin yaron na tsawon daƙiƙa 5 sannan a saki. Ya kamata launi ya dawo cikin ** kasa da daƙiƙa 2 *. Cikewar capillary na daƙiƙa 3 ko ya fi tsayi, sanyin gaɓoɓin gaɓoɓi, ko fatalwar fata/ashen fata yana nuna cewa hanjin da aka toshe yana kuka mai yawa na plasma ("tazarar ta uku") zuwa bangon hanji da kogon ciki, yana haifar da farkon hypovolemic shock.
• Duba Adadin Zuciya da Tsarin Numfashi: Matsakaicin bugun zuciya sama da 160 zuwa 180 bugun minti daya a cikin jarirai (ko da tsakanin kukan kukan lokacin da jaririn ke kwance a hankali) alama ce mai mahimmanci na asarar ruwa, ischemia na hanji, ko kamuwa da cutar sepsis.
• Ki duba Kalar Amai akan Farar Tufafi: Koyaushe kama ko duba amai akan farar tawul ko takardar.
• ** Farar, bayyananne, ko rawaya curdled madara/abinci:** Yawan amai da wuri da wuri ya jawo ta hanyar miƙewar jijiyar farji yayin da aka ja mesentery zuwa cikin hanji.
• ** Lemun tsami-kore mai haske ko ruwan alayyaho-kore mai duhu (Bilious Vomiting):** Yana tabbatar da cikakkiyar toshewar hanji a ƙarƙashin ampulla na Vater; faɗakar da ma'aikaciyar jinya nan da nan da isowa.
• Duba diaper kuma a ƙidaya diaper a cikin sa'o'i 12 da suka gabata: Cire diaper gaba ɗaya yayin jarrabawa, duka biyu don bincika stool don jinin sihiri ko jajayen gelatin "currant jelly", sannan a duba duka ɓangarorin ƙwanƙwasa da maƙarƙashiya / labia *** don tabbatar da yaron ba shi da ciwon damuwa.
• Nemi Alamar Rawa da Cikawar Babban Quadrant Dama: Lokacin da jaririn ya huta a tsakanin kururuwa, likita a hankali yana lanƙwasa ciki yakan ji ƙaƙƙarfan, ɗan taushi, mai lanƙwasa ** silinda mai siffar tsiran alade a cikin dama babba quadrant ko tsakiyar epigastrium ** (inda na'urar hangen nesa tana zaune a cikin madaidaicin madaidaicin madaidaicin), yana jin komai. (* Alamar rawa**) saboda an ciro cecum da bawul ɗin gidaocecal zuwa sama daga matsayinsu na yau da kullun.

Lambobin gaggawa na yanki da ka'idojin hukumar¶

Abin da ake zargin intussusception shine tiyata mai mahimmanci na yara da gaggawa na rediyo:

• Amurka da Kanada: Kiran kira 911 ko kuma a ci gaba da gaggawa zuwa mafi kusa ** Sashen Gaggawa na Yara / Asibitin Yara** (tunda cibiyoyin kula da gaggawa na al'umma da yawancin manya-kawai ERs masu zaman kansu ba su da likitan rediyo na yara akan wurin don yin raguwar iska / saline enema). An gudanar da shi ƙarƙashin ** Cibiyar Nazarin Ilimin Yara na Amirka (AAP)** da ** Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru na Amirka (APSA)
• United Kingdom: Danna 999 ko kuje asibiti kai tsaye Sashen Gaggawa na Yara (A&E). Karkashin ka'idojin NICE Mugun Ciwon Ciki da Kwalejin Sarauta ta Likitoci / BSPED, jarirai da ke da amai mai yawa ko da ake zargi da kamuwa da ciwon ciki suna fuskantar aikin tiyata na yara nan da nan.
• ** Tarayyar Turai:** Kiran Kira 112. An gudanar da shi a ƙarƙashin Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru ta Turai (EUPSA).
• ** Ostiraliya da New Zealand:** Kiran kira 000 a Ostiraliya ko 111 a New Zealand. An gudanar da shi a ƙarƙashin ** Asibitin Yara na Royal (RCH) Sharuɗɗan Ayyuka na Clinical na Melbourne don Hannun Hannu**.
• Indiya da Asiya-Pacific:* Dial 112 (ko 108 a Indiya),995* a Singapore,119* a Japan da Koriya ta Kudu, ko kuma 999 a Malaysia da Hong Kong. Ci gaba zuwa babban asibiti tare da duban dan tayi na yara na awa 24 da tiyatar yara.

Tambayoyin da ake yawan yi¶

Me yasa jaririn da ke da hanji ya yi kururuwa kowane minti 15 zuwa 20 sannan ya yi shuru ko barci a tsakani?¶

Ƙananan hanji na ɗan adam yana yin kwangila a cikin raƙuman ruwa (peristalsis) kowane minti 15 zuwa 20 don ciyar da abinci gaba. A cikin intussusception, a duk lokacin da igiyar igiyar igiyar ruwa ta buga na'urar hangen nesa na hanji, yana da ƙarfi ya matse hanjin da ke cikin tarko ya ja kan ƙwayar jijiyarsa mai wadatar jijiyoyi, yana haifar da ciwo mai tsanani na minti 2 zuwa 5 inda jaririn ya yi kururuwa ya ja gwiwoyi biyu zuwa kirji. Lokacin da igiyar ƙanƙara ta wuce, ciwon ya tsaya a ɗan gajeren lokaci, yana barin jariri ya yi fari, gumi, da gajiya ko kuma ya yi rauni sosai har sai igiyar ruwa na gaba ya zo bayan minti 15.

Me yasa hanjin intussusception zai sa jariri ya zama kamar yana da cutar sankarau ko matsalar kwakwalwa?¶

A cikin kashi 10 zuwa 20 cikin 100 na lokuta, yunwar iskar oxygen, bangon hanji da aka matsa yana fitar da adadi mai yawa na peptides na endogenous opioid-kamar peptides (endorphins) da cytokines masu kumburi a cikin jinin jariri. Wadannan opioids na dabi'a suna aiki akan kwakwalwar jariri don haifar da gajiya mai zurfi, sautin tsoka (floppiness), kallo mara kyau, da ƙananan yara, wani lokaci kafin jaririn ya wuce jini a cikin ɗakin su ko kuma ya nuna ciwon ciki. Likitoci suna kiran wannan "encephalopathic ko rashin jin daɗi," kuma saurin duban ciki a gefen gadon yana bayyana toshewar hanjin da ke ɓoye.

Menene "currant jelly stool" yayi kama, kuma duk jariran da ke da ciwon hanji suna da shi?¶

Currant jelly stool yayi kama da ja mai duhu ko maroon gelatinous jam gauraye a cikin diaper. Yana faruwa ne lokacin da cunkoson jijiyoyi a cikin hanji na wayar tarho ya sa rufin mucosal yayi toshewa da zub da jini mai kauri daga sel goblet na hanji. Duk da haka, ƙasa da kashi 25 zuwa 50 na jarirai suna da alamun jelly stool a bayyane lokacin da suka fara isa dakin gaggawa saboda alamar ƙarshen mucosal ischemia; kar a jira ganin jini a cikin diaper kafin a je asibiti.

Ta yaya enema mai iska ko saline ke gyara hanji mai na'urar hangen nesa ba tare da tiyata ba?¶

A lokacin raguwar enema na duban dan tayi ko X-ray, likitan yara na yara yana sanya bututu mai laushi a cikin duburar yaron kuma a hankali yana gabatar da iskar likitanci mai kayyade (pneumatic enema) ko ruwan gishiri mai dumi (hydrostatic enema) cikin babban hanji. Lallausan ginshiƙi na iska ko ruwa yana matsawa kan ƙarshen ƙananan hanji da aka yi wa na'urar hangen nesa kamar fistan, yana buɗe na'urar hangen nesa ta baya ta hanjin har sai ya dawo cikin matsayinsa na yau da kullun. Wannan aikin ba tiyata yana samun nasara a kashi 85 zuwa 90 na yara lokacin da aka yi su da wuri.

Shin allurar rigakafin rotavirus ko cutar sanyi ta yau da kullun na iya haifar da intussusception?¶

Yawancin lokuta na intussusception jarirai suna haifar da kamuwa da cuta na yau da kullum (kamar adenovirus) ko ƙwayar cuta na ciki wanda ke haifar da ƙwayar lymph na yau da kullum a cikin ƙananan hanji (Peyer's patches) don kumbura kuma yayi aiki a matsayin "maganin jagora" na jiki wanda ke jawo shi cikin hanji. Maganin rotavirus na baka yana ɗaukar ɗan ƙaramin haɗari (kimanin ƙarin lokuta 1 zuwa 5 a cikin kowane jarirai 100,000 da aka yi wa alurar riga kafi, musamman a cikin kwanaki 7 na farko bayan kashi na farko ko na biyu), yayin da suke hana dubunnan cututtukan rotavirus na rashin ruwa a asibiti a lokaci guda; kawai an shawarci iyaye su kalli kukan guiwa-zuwa-kirji a cikin mako guda bayan allurar.

Shin ciwon intussusception zai iya sake faruwa bayan an gyara shi?¶

Ee. Intussusception yana komawa a cikin kimanin kashi 8 zuwa 12 na yara bayan nasarar nasarar iska ko raguwar enema na saline, tare da kusan rabin wadanda suka sake faruwa a cikin sa'o'i 24 zuwa 72 na farko yayin da ƙwayar lymphoid mai kumbura a cikin bangon hanji yana ci gaba da raguwa. Idan kururuwar cyclic, yanayin gwiwoyi-zuwa-kirji, amai, ko dawowar gajiya, komawa kai tsaye zuwa sashin gaggawa, lokuta masu maimaitawa yawanci ana iya sake rage su tare da wani enema, kodayake maimaita maimaitawa da yawa suna haifar da kimantawa ga madaidaicin jagorar tsari kamar karkatarwar Meckel.

Tushen da jagorar hukuma¶

• American Academy of Pediatrics (AAP) & American Pediatric Surgical Association (APSA, United States): Clinical Practice Guidelines and Surgical Outcomes for Pediatric Ileocolic Intussusception.
• ** Asibitin Yara na Royal (RCH) Melbourne (Ostiraliya):** *Jagorancin Ayyukan Kula da Lafiya: Ƙwararren Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru.
• Hukumar Kiwon Lafiya ta Duniya (WHO): Mai Mugun Magani a cikin Jarirai da Yara: Hatsari, Gabatarwar asibiti da Gudanarwa, Ra'ayin Duniya.
• ** Cibiyar Kula da Lafiya ta Kasa (NICE) & Royal College of Paediatrics and Child Health (RCPCH, United Kingdom):** *Ganewa da bambance-bambancen Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar Cutar korona da kuma Ciwon Amai.
• Ƙungiyar Turai ta Radiology na Yara (ESPR): Sharuɗɗa don Binciken Bincike na Ultrasound da Hoto-Jagorancin Rage Jigilar Jiki a Yara.

Jagora masu alaƙa¶

• Toshewar hanji, ƙwanƙwasawa, da alamun gaggawa
• Henoch-Schonlein purpura (IgA vasculitis), palpable purpura, da intussusception triage.
• Pyloric stenosis, zubar da jini mara nauyi, da kuma alkalosis na rayuwa
• Appendicitis, ruptured appendix, peritonitis, da dama ƙananan ciwon quadrant
• Guba abinci, m gastroenteritis, da rashin ruwa