Pyloric Stenosis: Ọgbụgbọ na-adịghị mma n'ime ụmụ ọhụrụ 3 ruo-8-izu, Mass Olive, na Hypochloremic Metabolic Alkalosis¶

Infantile Hypertrophic Pyloric Stenosis (IHPS) bụ nnukwu ahụike ụmụaka na ịwa ahụ mberede nke mgbanaka akwara dị nro nke ** pylorus **, valvụ na-emepụta valvụ na-ejikọta ala nke afọ na akụkụ mbụ nke eriri afọ (duodenum), na-agba ngwa ngwa ma na-agbatị n'oge ** mbụ 2 ruo 8 izu nke ndụ. N'ihi na mmiri ara ara ma ọ bụ usoro enweghị ike isi na afo si n'afọ banye n'ime eriri afọ, ebe bile si na gallbladder na-abanye n'okpuru valvụ ahụ egbochiri, nwa ọhụrụ na-etolite kpochapụ ** ike, nke na-adịghị mma (na-acha ọcha, na-acha akwụkwọ ndụ akwụkwọ ndụ, na-acha akwụkwọ ndụ akwụkwọ ndụ) na-agbọ agbọ *** ozugbo nri ọ bụla, na-anọgide na-eri anụ ma na-anwa inye nri ọzọ ozugbo (*) agụụ na-agụ agụụ. Ebili mmiri afọ nke aka ekpe gaa aka nri gafee afọ elu, ma nwee nnukwu uru ahụ nwere ike ibugharị **"olive" n'elu afọ. Ọ bụrụ na nwa ọhụrụ na-erubeghị ọnwa 3 na-etolite ọgbụgbọ mgbe nri gasịrị, fontanelle sunken (ntụpọ nro), akwa akwa akọrọ, ike ọgwụgwụ, ma ọ bụ vomit ọ bụla nwere agba akwụkwọ ndụ akwụkwọ ndụ, kpọọ mpaghara gị. nọmba mberede ma ọ bụ gaa na ngalaba mberede ụmụaka kacha nso ozugbo. Mgbe ị na-akwado maka njem, nyochaa ntuziaka metụtara ya intussusception na telescoping bowel na ụmụ ọhụrụ, mgbochi afọ na midgut volvulus, na nsị nri, gastroenteritis, na akpịrị ịkpọ nkụ.

Ụkpụrụ dị mkpa na-azọpụta ndụ nke nlekọta mberede ụmụaka bụ na ** pyloric stenosis bụ ihe mberede ahụike ahụike tupu ọ bụrụ ihe mberede ịwa ahụ **: n'ihi na nwa ọhụrụ na-agbọ agbọ acid hydrochloric dị ọcha (HCl) kwa ụbọchị, ọbara ha na-etolite siri ike hypochloremic, hypokalemic metabolic alkalosis na akpịrị ịkpọ nkụ. Ịkpọrọ nwa nwere alkalosis metabolic ozugbo banye n'ime ụlọ ịwa ahụ maka ** Ramstedt pyloromyotomy ** tupu ha edozi chloride ọbara ha, potassium, bicarbonate na oke mmiri na ** intravenous. 0.9% NaCl (Saline nkịtị) + potassium chloride nwere ike ibute ndụ egwu post-anesthetic Central apnea (ịkwụsị iku ume mgbe a wachara ya ahụ) n'ihi na ụbụrụ ụbụrụ alkalotic nke nwa ọhụrụ na-eche na ọ dịghị mkpa iku ume.

Mee nke a ugbu a¶

1. **Gaa na Ngalaba Mberede Ụmụaka kacha nso ozugbo (ma ọ bụ kpọọ nọmba mberede mpaghara gị ma ọ bụrụ na nwa ahụ na-agwụ ike, floppy, ma ọ bụ vomiting green bile). nọmba mberede. Gwa onye nọọsụ nkewa n'ụzọ doro anya: *"Nwa ọhụrụ mere agadi [X] izu nwere ọgbụgbọ na-aga n'ihu mgbe nri gachara, agụụ na-agụ ya ozugbo agbọ agbọ, na diapers na-ebelata, nke a na-enyo enyo na pyloric stenosis.
2. ** Nyochaa agba nke vomit na akwa ọcha ozugbo (White Milk vs. Green Bile bụ ndụdụ 5-alarm n'okporo ụzọ).**
3. ** Mmiri ara ehi na-acha ọcha, nke doro anya ma ọ bụ odo odo (Na-abụghị Bilious): ** Omuma maka ** pyloric stenosis *** (ihe mgbochi dị * n'elu * oghere bile duct).
4. ** Ọkụ na-egbuke egbuke-acha akwụkwọ ndụ akwụkwọ ndụ ma ọ bụ mmiri mmiri na-acha akwụkwọ ndụ akwụkwọ ndụ (Bilious Vomiting): *** Nke a bụ ** BỤGHỊ ** pyloric stenosis, ọ bụ ** Malrotation na Midgut Volvulus ** (eriri eriri afọ gbagọrọ agbagọ na-ekegide ọbara ya n'okpuru bile duct) ruo mgbe egosipụtara na ọ bụghị, nke nwere ike igbu obere eriri afọ ahụ n'ime awa ole na ole ma chọọ ụgbọ mberede mberede ngwa ngwa.
5. ** Kwụsị nri ọnụ niile (ọ dịghị mmiri ara ara, usoro nri, mmiri, ma ọ bụ Pedialyte) ozugbo ị na-aga na ngalaba mberede.HCl) na chloride na-esi n'ọbara nwa ọhụrụ pụta, na-etinyekwa ohere n'ime ngụgụ.
6. Ọ dịghị mgbe inye nwa ọhụrụ mmiri nkịtị, ọgwụ a gwakọtara agwakọta, teas herbal, ma ọ bụ ọgwụ na-egbochi ọgbụgbọ.** Ịnye nwa ọhụrụ na-agbọ agbọ mmiri na-egbu egbu ** hyponatremic ụbụrụ ọzịza (ihe ọdịdọ)** na mgbochi emetics (ondansetron, promethazine, metoclopramide) enweghị ike imepe mgbanaka akwara hypertrophied n'ụzọ dị ize ndụ.
7. Gụkwuo ọnụ ọgụgụ diapers nke mmiri n'ime awa 24 gara aga wee lelee ebe dị nro nwa (anterior fontanelle) na ụcha akpụkpọ ahụ. Rịba ama mgbe nwa ọhụrụ chara chara, ma ntụpọ dị nro n'elu isi ọ na-ada ụda, ma nwa ahụ na-ebe akwa na-enweghị anya mmiri, na ma ọcha nke anya ma ọ bụ akpụkpọ ahụ na-ele anya obere odo (**icteropyloric insten of children's pyloric syndrome) bilie bilirubin na-apụtaghị ìhè).
8. ** Weta ndekọ ọgwụ nje ọ bụla enyere nwa ọhụrụ ma ọ bụ nne (karịsịa Erythromycin ma ọ bụ Azithromycin). ikpughe n'oge ** mbụ 2 izu nke ndụ *** na-abawanye ohere nke pyloric stenosis ** 8-n'ogige atụrụ na 10-fold.

Osisi mkpebi: ịbelata vomiting nwa ọhụrụ (Bilious Volvulus vs. Pyloric Stenosis vs. Reflux)¶

flowchart TD
    Start["Agbọ agbọ n'ime nwa ọhụrụ (amụọ ruo izu iri na abụọ)"] --> ColorCheck{"Nzọụkwụ 1: Kedu agba bụ vomit na akwa ọcha?"}

    ColorCheck -->|"GREEN NA-egbuke egbuke ma ọ bụ odo odo-acha ndụ ndụ gbara ọchịchịrị (Agba aghara)"| Volvulus["5-MGBE MGBE Ịwa Ahụ: Mgbochi a na-enyo enyo na Midgut Volvulus. Kpọọ 911/112/999 ozugbo, Kpọmkwem NPO, Ọmụmụ ihe dị iche iche nke elu GI na mberede & Usoro Ladd ozugbo."]

    ColorCheck -->|"Mmiri ara ehi na-acha ocha ma ọ bụ nke dị ọcha (Agbọ na-adịghị njọ)"| PatternCheck{"Kwụpụ 2: Ọgbụgbọ ọ na-arụ ọrụ ike/projectile mgbe ọ fọrọ nke nta ka ọ bụrụ nri ọ bụla n'ime nwa dị izu 2 ruo 8 nke chọsiri ike inye nri ọzọ ('Agụụ Vomiter'), na-efunahụ ibu ma ọ bụ obere diaper mmiri?"}

    PatternCheck -->|"EE: PYLORIC STENOSIS enyo enyo"| Pyloric["Nleta Ngalaba Mberede Ụmụaka ngwa ngwa: NPO siri ike, Lelee Gas Blood & Electrolytes (Cl, K, HCO3), Mee Pyloric Ultrasound ('3-14-4 Iwu'> 3 mm oké,> 15 mm ogologo)"]

    PatternCheck -->|"Mba: Lelee Sepsis System / Adrenal / Metabolic Signs"| SickCheck{"Nwa ọhụrụ ahụ ọ na-agwụ ike, ahụ ọkụ ma ọ bụ hypothermic, tachypneic, ma ọ bụ na-egosi potassium + sodium dị ala (nsogbu na-emebi nnu adrenal adrenal hyperplasia)?"}

    SickCheck -->|"EE"| SepsisCAH["Mweghachi ụlọ ọgwụ ozugbo: Kwụsị Sepsis Neonatal, Meningitis, Ọrịa Urea Cycle Disorder, ma ọ bụ Congenital Adrenal Hyperplasia (CAH)"]

    SickCheck -->|"Mba: Nkwụghachi ụgwọ 'happy spitter' na-enweghị mgbakasị, uru ịdị arọ na-aga n'ihu, diapers 6+ kwa ụbọchị"| GER["Gastroesophageal Reflux (GER): Ndokwa ziri ezi 20-30 min mgbe nri gasịrị, obere nri ugboro ugboro, nleba anya ụmụaka."]

    Pyloric --> Resus["Kwụpụ 3: MKPỤTA Ọgwụ Ahụike Mbụ (awa 12-24+): IV 0.9% Nkịtị Saline Bolus + D5 0.9% NaCl na KCl ruo Chloride>= 100 mEq/L na Bicarbonate <28-30 mEq/L, wee Laparoscopic Ramstedtyloromy"]

Pathophysiology: anatomi nke hypertrophed pylorus na ihe mere electrolytes ji daa¶

1. Ihe kpatara mgbanaka akwara pyloric na-agbaba na izu 3 ruo 6¶

Mgbe a na-amụ nwa, sphincter pyloric nwa ọhụrụ na-adị nnọọ mma. N'ime izu mbụ ** 2 ruo 8 nke ndụ ** (ihe ngosi mgbasa ozi na ** izu ise nke afọ ; na-emetụta ** 2 ruo 4 kwa 1,000 ọmụmụ dị ndụ , yana ** 4: 1 nwoke na nwanyị , ọkachasị n'ime ụmụ nwoke eburu ụzọ mụọ), okirikiri ahụ dị nro nke pylorus na-enweta akara * hypertrophy (cell na hyperplasia). - Enweghị Neuronal Nitric Oxide Synthase (nNOS): N'ime akwara pyloric nkịtị, irighiri akwara na-ahapụ nitric oxide (NO) iji mee ka sphincter dị jụụ ka mmiri ara ehi wee banye na duodenum. Ụmụ ọhụrụ nwere pyloric stenosis nwere ụkọ mpaghara nke neuronal nitric oxide synthase na sel interstitial nke Cajal; sphincter anaghị ada jụụ, afọ na-agbakọkwa ọnụ megide ọnụ ụzọ mechiri emechi, na-eme ka mgbanaka ahụ ike pyloric na-ebuli elu dị ka ihe na-ebu ibu ruo mgbe ọ ga-etolite nnukwu oke oliv nke na-emechi lumen. - ** Nnukwu ihe egwu egwu: 1. ** Mmekọahụ nwoke na ọnọdụ ọkpara (ụmụ nwoke na-emetụta ugboro 4 ruo 5 karịa ụmụ agbọghọ; ihe dị ka 30% bụ ụmụ nwoke mbụ). 2. ** Akụkọ ezinụlọ *** (ọ bụrụ na nne nwere pyloric stenosis dị ka nwa ọhụrụ, nwa ya nwoke nwere ihe ize ndụ 20% na nwa ya nwanyị nwere ihe ize ndụ 7%). 3. ** Mkpughe ọgwụ nje macrolide (Erythromycin ma ọ bụ Azithromycin): Enyere nwa amụrụ ọhụrụ ozugbo n'ime ụbọchị iri na anọ mbụ nke ndụ (dịka ọmụmaatụ, maka prophylaxis pertussis ma ọ bụ * Chlamydia conjunctivitis) ma ọ bụ site na mmiri ara ara. 4. Nri karama na ise siga nke nne n'oge ime.

ANATOMY OF INFANTILE HYPERTROPHIC PYLORIC STENOSIS vs. MIDGUT VOLVULUS

      [ ESOPHAGUS ]
            |
     +------+------+
     |             |   <-- Gastric Peristaltic Waves Ripple Left-to-Right
     |   STOMACH   |       Across Upper Belly Trying to Push Milk Through
     | (Distended) |
     +------+------+
            |
   =========+=========
  (( HYPERTROPHIED   )) <-- PYLORIC "OLIVE" MASS (Wall > 3 mm, Length > 15 mm)
  (( PYLORIC SPHINCTER))    BLOCKS STOMACH OUTLET ABOVE THE BILE DUCT
   =========+=========      ===> VOMIT IS ALWAYS NON-BILIOUS (WHITE MILK)
            |
     +------+------+
     |  DUODENUM   |<====== AMPULLA OF VATER (Common Bile Duct Enters Here.)
     +------+------+        * If obstruction is BELOW here (Midgut Volvulus /
            |                 Duodenal Atresia), VOMIT IS BRIGHT GREEN BILE.

2. The 3-Step Biochemical Cascade: Olee otú vomiting si ebute Hypochloremic, Hypokalemic Metabolic Alkalosis na "Paradoxical Aciduria"¶

Ịghọta nsogbu electrolyte nke pyloric stenosis dị mkpa n'ihi na ** imezi chloride na ụkọ olu bụ ihe na-azọpụta ndụ nwa ọhụrụ ***:

1. ** Nzọụkwụ 1 - nnukwu mfu nke Hydrochloric Acid (HClSite na afọ (hypochloremic alkalosis):**
2. N'ihi na mgbochi ahụ dị * n'elu * duodenum (ebe alkaline pancreatic bicarbonate na-abanye), afọ nwa ọhụrụ na-agụnye naanị ** ihe ọṅụṅụ gastric dị ọcha bara ụba na Hydrogen (H+chloride (Cl-sodium (Na+Potassium dị ntakịrị (K+)**.
3. Maka onye ọ bụla H+ ion mkpụrụ ndụ parietal nke afọ na-apụ apụ wee daa na vomit, ha na-atụfu ** otu Bicarbonate (HCO3-) ion banye n'ọbara nwa ọhụrụ** ("mmiri mmiri alkaline"). Dị ka ọ na-adịkarị, acid ahụ na-erute duodenum wee kpalite ntọhapụ bicarbonate pancreatic iji dozie ọbara; na pyloric stenosis, a na-agbapụta acid n'elu ala, na-ahapụ ọbara elu nke elu igwe ** Bicarbonate (HCO3- > 30 ruo 40 mEq / L)** na ọbara dị ala nke ukwuu ** chlorideCl- 85 ruo 95 mEq/L)**.
4. ** Nzọụkwụ 2 - akpịrị ịkpọ nkụ na-ebute Renin-Angiotensin-Aldosterone Surge (Hypokalemia):**
5. Ka mmiri na-agwụ nwa ọhụrụ na hypovolemic, akụrụ na-ahụ ka ọ̀tụ̀tụ̀ ọbara dị ala dị ize ndụ ma na-ahapụ nnukwu Aldosterone.
6. Aldosterone na-enye iwu tubules akụrụ dị anya ka ** reabsorb molecule ọ bụla nke sodium nwere ike ime.Na+*** iji mee ka ọ̀tụ̀tụ̀ ọbara ji erugharị n'ahụ́ dị ndụ, ma ịdọrọ nke ọma Na+ laghachi n'ime ọbara, akụrụ ga-apụ apụ nke ọma ** Potassium (K+*** n'ime mmamịrị, na-ebuba ọbara ọbara potassium dị ala (** Hypokalemia, K+ < 3.5 mEq/L**).
7. ** Nzọụkwụ 3 - "Paradoxical Aciduria" (Ihe kpatara nwa Alkaline ji agbafe mmamịrị acid):**
8. Na mbido, akụrụ na-anwa idozi ọbara alkaline site na ịtụba bicarbonate n'ime mmamịrị (na-eme ka mmamịrị alkaline).
9. Otu oge ** chloride (Cl-*** na potassium (K+)** na-agwụcha nke ukwuu, akụrụ enweghị anions chloride nke fọdụrụ ka ọ na-agbakọ n'akụkụ sodium, ọ nweghịkwa potassium cations fọdụrụ iji zụta sodium na tubule distal. Na-achọsi ike ịchekwa sodium na mmiri iji mee ka obi nwa ahụ na-akụ aka, a na-amanye nfuli aldosterone nke akụrụ na ** excrete Hydrogen (H+ acid) ion n'ime mmamịrị maka mgbanwe sodium (Na+)**.
10. A na-akpọ nke a ** Paradoxical Aciduria : ọbara nwa dị ize ndụ ** alkaline (pH > 7.50), ma mmamịrị nwa bụ ** acidic ** (urine pH < 5.5), na-eme ka ọbara alkalosis na-akawanye njọ kwa awa ruo mgbe a na-agbanye n'ime eriri afọ ** Chloride (0.9% NaClPotassium (KCl)** ka e nyere.

Ịmata Pyloric Stenosis vs. Midgut Volvulus, Gastroesophageal Reflux (GER), na Nsogbu Adrenal¶

Tebụlụ ntụnyere Clinical & biochemical: ọdịiche dị n'ime nwa ọhụrụ na-agbọ agbọ¶

Kedu ka ndị dọkịta si achọ "Peristaltic Wave" wee nwee mmetụta "Olive Mass"¶

1. ** Ikiri ebili mmiri n'aka ekpe gaa aka nri:** Kpuchie afọ nwa ọhụrụ n'ime ụlọ na-ekpo ọkụ mgbe ọ na-enye pacifier etinyere na mmiri shuga (ma ọ bụ na-ekiri obere oge tupu agbọpụta). Ị nwere ike ịhụ nhụsianya n'ụdị gọlfụ nwere n'okpuru ọgịrịga ekpe, jiri nwayọọ nwayọọ na-agafe n'afọ elu site na ** aka ekpe gaa n'aka nri ** ma pụọ ​​​​n'aka nri nke etiti ahịrị ka akwara afọ na-agbagide megide pylorus egbochiri.
2. ** Palpating the Epigastric "Olive":** Mgbe afọ tọgbọrọ chakoo (ma ọ bụ decompressed) na akwara afọ nwa ahụ dị jụụ (site n'ịgbanwe hips nwa ma mee ka ha ṅụọ na pacifier), iji nwayọọ nwayọọ na-agbanye n'okpuru imeju imeju nanị n'akụkụ aka nri nke midline na-ekpughe ihe siri ike, dị nro, mobile, 1.5-centimes na-eche kpọmkwem ** 1.5. olulu-n'ime oliv *** (** 70% ruo 90% uru amụma dị mma ** mgbe onye nyocha nwere ahụmahụ nwere mmetụta).

Nchọpụta ụlọ ọgwụ: Ultrasound "3-14-4 (ma ọ bụ 3-15-4) Iwu"¶

Taa, ndị dọkịta adịghịzi mkpa ịmanye nwa ọ bụla ka ọ ṅụọ barium maka x-ray ọ gwụla ma ultrasound bụ ihe na-adịghị mma. Ngwa ngwa, enweghị mgbu, radieshon na-enweghị radieshon **Pyloric Ultrasound *** nwere **98% ruo 100% uche na nkọwapụta ***:

ULTRASOUND DIAGNOSTIC CRITERIA FOR PYLORIC STENOSIS ("THE 3 - 15 - 4 RULE")

1. Pyloric Muscle Wall Thickness (Single Wall):  >= 3 millimeters (Normal is < 2 mm)
2. Pyloric Canal Length (Longitudinal View):     >= 15 millimeters (or >= 14-17 mm)
3. Transverse Pyloric Diameter (Target View):    >= 14 millimeters (or Channel > 4 mm)
4. Functional Real-Time Observation:             Zero gastric emptying through the
                                                 pyloric channel + "Antral Nipple Sign"
                                                 and "Cervix Sign"

Ngwọta ụlọ ọgwụ nwere agba abụọ: IV Electrolyte Mmezi Mbụ, Mgbe ahụ Ramstedt Pyloromyotomy¶

Nkeji 1: Mweghachi ahụike tupu arụ ọrụ (awa 12 ruo 48)¶

Tupu ekpochapụ nwa ahụ maka nkụnwụ ahụ, ndị na-ahụ maka ahụike ụmụaka na ndị otu ịwa ahụ na-eme usoro ọgwụgwọ siri ike nke intravenous na usoro mweghachi electrolyte:

1. ** Kpamkpam NPO:** Kwụsị nri ọnụ niile. (A na-ezere tubes nasogastric na-emekarị ma ọ bụrụ na nwa ahụ na-aga n'ihu na-agbọ agbọ mgbe NPO na-aga n'ihu, n'ihi na mmiri NG na-aga n'ihu na-amịkọrọ ọbụna hydrochloric acid na chloride n'ime afọ ma na-agbatị metabolism alkalosis.).
2. ** Mweghachi olu nke mbụ (Ọ bụrụ na akpọnwụ akpọnwụ): ** Na-elekọta ** 10 ruo 20 ml / kg boluses intravenous nke Isotonic. 0.9% Sodium Chloride (Saline nkịtị)** ruo mgbe ọ̀tụ̀tụ̀ obi, njupụta nke capillary, na mmepụta mmamịrị na-ahazi. ** Ejila Lactated Ringer's ma ọ bụ Plasmalyte **, n'ihi na lactate na acetate na-agbanwe site na imeju ka ọ bụrụ * more bicarbonate, na-akawanye njọ nke alkalosis.
3. ** Nlekọta + Chloride ngbanwe & Infusion Potassium: ** Gbaa ọsọ ** 1.5 ugboro mmezi mmiri mmiri IV ** iji 5% Dextrose in 0.9% NaCl (ma ọ bụ 0.45% NaCl ọ bụrụ na ọ dị nro), na ** ngwa ngwa nwa ọhụrụ ahụ na-amịpụta** (na-akwado ọrụ akụrụ), tinye 20 to 30 mEq/L of Potassium Chloride (KCl) .
4. Ebumnuche mkpochapụ ụlọ nyocha nke pre-Anesthesia: Tinyegharịa panel metabolic bụ isi kwa awa 6 ruo 12 ọ bụla. A na-ekpochapụ nwa ọhụrụ maka ụlọ ịwa ahụ **NAANỊ mgbe emezuru ebumnuche anọ niile ***:
5. ** Serum bicarbonate (HCO3-) / Mkpokọta CO2: ** ** <28 ruo 30 mEq / L** (dị mma < 26 to 28 mEq/L)
6. ** Ọbara chlorideCl-*** *** = 100 mEq/L**
7. • Potassium ọbara (K+): ** 3.5 ruo 5.0 mEq / L *** (nkịtị)
8. ** Ọbara sodium (Na+): *** *** = 132 ruo 135 mEq / L ** na ** Mpụta mmamịrị siri ike (> 1 to 2 mL/kg/hr)**.

Nkeji 2: Mmezi ịwa ahụ (Laparoscopic Ramstedt Pyloromyotomy)¶

Ozugbo kemịkalụ ọbara zuru oke, dọkịta na-awa ụmụaka na-eme ** Ramstedt Extramucosal Pyloromyotomy ** (na-abụkarị site na mkpịsị mkpịsị mkpịsị mkpịsị mkpịsị ugodi 3-millimita ma ọ bụ mgbawa eriri afọ ịchọ mma) n'ime naanị nkeji 20 ruo 30 : - ** Otu usoro Ramstedt si arụ ọrụ: Dọkịta na-awa ahụ na-eme mbepụ ogologo oge gbadaa n'èzí mgbanaka akwara pyloric rock-hard hypertrophied ma na-eji ihe na-agbasa nke ọma na ** kewaa eriri akwara ahụ gbasapụrụ ruo na oyi akwa submucosal na-enweghị ike imeghe tube mucosal dị n'ime dị nro. - Ihe mkpuchi mucosal dị n'ime adịghị emebi emebi ozugbo na-apụta n'èzí n'ime mgbawa ahụ ike gbawara agbawa, na-emepe ụzọ obosara, nke kwesịrị ekwesị site na afọ banye duodenum. - Nri na mgbake na-aga n'ihu: A na-amalitegharị inye nri ọnụ (mmiri ara ma ọ bụ usoro) naanị ** 4 ruo 6 awa mgbe ịwachara ahụ **. Rịba ama na ** ịgbasa mmiri dị nro ma ọ bụ 1 ruo 2 obere vomits n'ime awa 24 mbụ mgbe ịwachara ahụ bụ ihe nkịtị ** (site na edema ịwa ahụ nke pylorus na mgbatị afọ na-adịgide adịgide) na-edozi ngwa ngwa; Ihe karịrị 95% nke ụmụ ọhụrụ na-ala n'ụlọ a gwọrọ kpam kpam n'ime awa 24 ruo 36 nke ịwa ahụ, na-esote nlekota pulse oximetry apnea n'oge ọnụnọ ụlọ ọgwụ ha.

Ndepụta nzọụkwụ site n'ụlọ na ụgbọ ihe mberede akpịrị ịkpọ nkụ maka ụmụ ọhụrụ¶

N'ihi na nwa ọhụrụ dị izu anọ na-atụ naanị 3.5 ruo 4.5 kilogram (7.7 ruo 10 pound) ma nwee ntakịrị mkpokọta ọbara na-ekesa n'ihe dịka millilita 280 ruo 360, na-efunahụ naanị 30 ruo 50 milliliters nke mmiri n'otu vomit projectile nwere ike ime ka nwa ọhụrụ banye n'ime mmiri ọkụ dị nro. awa. Jiri tebụl ụlọọgwụ a chọpụta oke akpịrị ịkpọ nkụ nwa gị ka ọ na-akwado maka njem ngalaba mberede:

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

Nwa ọhụrụ ọ bụla na-erubeghị ọnwa 3 nwere vomiting siri ike, ike ọgwụgwụ, ma ọ bụ vomiting siri ike chọrọ nyocha mberede ụlọ ọgwụ ozugbo:

• United States na Canada: Kpọọ 911 (ma ọ bụrụ na ọgbụgbọ, ike ọgwụgwụ, ma ọ bụ ujo) ma ọ bụ gaa ozugbo na ụlọ ọgwụ ụmụaka / Ngalaba Mberede ụmụaka***. Ejiri ya n'okpuru ** American Pediatric Surgical Association (APSA)** na ** American Academy of Pediatrics (AAP)** ụzọ ụlọ ọgwụ.
• United Kingdom: Kpọọ 999****************************************************** maọbụ gaa n'ụlọọgwụ ozugbo ** Ngalaba Mberede ụmụaka (A&E)**. N'okpuru NICE Nlekọta ọmụmụ nwa na ọgbụgbọ ụmụaka / ntuziaka BSPED, ịgba agbọ n'ime nwa ọhụrụ dị afọ 2 ruo 8 na-enye iwu ntugharị ụlọ ọgwụ ngwa ngwa otu ụbọchị maka nyocha ọbara gas/electrolyte na ultrasound.
• European Union: Kpọọ 112. Ejikwara n'okpuru European Pediatric Surgeons' Association (EUPSA) ntuziaka.
• Australia na New Zealand: Kpọọ 000 na Australia ma ọ bụ 111 na New Zealand. Ejiri ya n'okpuru Royal Children's Hospital (RCH) Ntuziaka Omume Clinical Melbourne: Pyloric Stenosis.
• India na Asia-Pacific: Kpọọ 112 (ma ọ bụ 108 na India),995 na Singapore,119 na Japan na South Korea, ma ọ bụ 999 na Malaysia na Hong Kong. Gaa n'ụlọ ọgwụ tertiary nwere ultrasound ụmụaka na ike ịwa ụmụaka.

Ajụjụ a na-ajụkarị¶

Kedu otu m ga-esi akọwa ọdịiche dị n'etiti reflux nwa nkịtị ("na-agbapụta") na pyloric stenosis?¶

Ntụrụndụ nwa ọhụrụ (gastroesophageal reflux) anaghị agba mbọ: mmiri ara ehi na-eji nwayọọ na-esi n'akụkụ ọnụ nwa na-atapụ n'oge ma ọ bụ mgbe ọfụchara, nwa ahụ na-ebuwanye ibu nke ọma, akwa diapers na-adịkwa mma. Pyloric stenosis na-amalitekarị n'agbata izu 3 na 6 ma na-esiwanye ike kwa ụbọchị ruo mgbe mmiri ara ehi ma ọ bụ usoro na-esi n'ọnụ pụta n'ime arc n'ofe ụlọ nri (ịgba agbọ) ozugbo ọ risịrị nri, ma nwa ahụ na-akwa ákwá ozugbo na mgbọrọgwụ agụụ ka e nye ya nri ọzọ ("onye agụụ na-agụ agụụ") mgbe anyị na-efunahụ ibu ma na-emepụta ihe ole na ole.

Gịnị mere akwụkwọ ndụ akwụkwọ ndụ (bilious) vomit na nwa amụrụ ọhụrụ ọbụna dị ngwa ngwa karịa pyloric stenosis?¶

Na pyloric stenosis, akwara mgbochi na-anọdụ ala na ọpụpụ afọ * n'elu * ampulla nke Vater ebe bile ndụ ndụ sitere na imeju na-abanye n'ime eriri afọ, yabụ pyloric stenosis vomit na-acha ọcha ma ọ bụ na-acha mmiri ara ehi mgbe niile (ọ naghị enwu gbaa). Ọ bụrụ na nwa ọhụrụ na-agbọ agbọ na-egbuke egbuke na-acha akwụkwọ ndụ akwụkwọ ndụ ma ọ bụ na-acha akwụkwọ ndụ akwụkwọ ndụ akwụkwọ ndụ, ihe mgbochi ahụ dị * n'okpuru* bile duct, nke kachasị dị ize ndụ na-akpata site na mmebi nke midgut volvulus, ebe obere eriri afọ ahụ gbagọrọ agbagọ n'akụkụ akwara isi ya ( akwara mesenteric dị elu). Midgut volvulus nwere ike ịkpata necrosis bowel necrosis na ọnwụ n'ime awa ole na ole ma chọọ ịwa ahụ mberede ngwa ngwa.

Kedu ihe kpatara dọkịta na-awa ahụ agaghị arụ ọrụ na pyloric stenosis nke nwa m ozugbo tupu inye mmiri IV maka otu ụbọchị?¶

Ụbọchị ịgba agbọ dị ọcha acid (hydrochloric acid) na-ahapụ nwa nwere obere chloride ọbara, obere potassium, na ọbara bicarbonate dị elu (hypochloremic metabolic alkalosis). Ebe iku ume dị n'ụbụrụ ụbụrụ nwa amụrụ ọhụrụ na-adabere na acid nkịtị na carbon dioxide dị n'ime mmiri azụ azụ iji kpalite ume ọ bụla. Ọ bụrụ na a na-etinye nwa ọhụrụ nwere alkalosis metabolic na-emeghị nke ọma n'okpuru mgbakasị izugbe tupu saline nkịtị na potassium chloride weghachi kemịkalụ ọbara nkịtị, nwa ahụ na-eche nnukwu ihe ize ndụ nke na-eyi ndụ egwu egwu na-egbu oge (ịkwụsị iku ume mgbe a wachara ya ahụ) na obi arrhythmias.

Kedu ihe kpatara ụfọdụ ụmụ ọhụrụ nwere pyloric stenosis ji enweta anya odo odo (jaundice)?¶

Ihe dị ka pasent 2 ruo 5 nke ụmụ ọhụrụ nwere pyloric stenosis na-etolite na-acha odo odo nke akpụkpọ ahụ na ọcha nke anya, ọnọdụ na-adịghị mma a na-akpọ "icteropyloric syndrome." Nnukwu agụụ caloric na akpịrị ịkpọ nkụ na-egbochi imeju enzyme (UGT1A1, otu enzyme ahụ metụtara ọrịa Gilbert) nke na-arụ ọrụ bilirubin na-apụtaghị ìhè. Ozugbo a wachara ya ahụ ma nwa ahụ maliteghachi nri mmiri ara ehi nkịtị, jaundice na-apụ n'anya kpamkpam n'ime ụbọchị ole na ole.

Ịṅụ erythromycin ma ọ bụ azithromycin kpatara pyloric stenosis nwa m?¶

Ọgwụ nje macrolide nke ọnụ, ọkachasị erythromycin na azithromycin, na-ejikọ ozugbo na ndị na-anabata motilin n'ime afọ nwa ọhụrụ, na-ebute mkpụkọ akwara dị ike, na-emegharị ugboro ugboro nke na-eme ka sphincter pyloric nwee hypertrophy. Nnyocha na-egosi na ụmụ ọhụrụ e nyere erythromycin ma ọ bụ azithromycin n'ime ụbọchị iri na anọ mbụ nke ndụ nwere ihe ize ndụ 8 ruo 10 nke ịmalite ịmalite pyloric stenosis.

Nwa m ọ ga-enwe nsogbu afọ ọ bụla na-adịte aka mgbe Ramstedt pyloromyotomy gasịrị?¶

Mba. A laparoscopic Ramstedt pyloromyotomy na-agwọta pyloric stenosis na-adịgide adịgide n'ime ihe karịrị pasenti 99 nke ụmụ ọhụrụ, na akwara pyloric gbawara agbawa na-adị nro ma na-agbanweghachi n'ogo nke ọma n'ime izu. Ozugbo a gwọchara ya, ụmụaka ndị nwere pyloric stenosis na-enwe mgbari nri nkịtị, uto nkịtị, ọ dịghịkwa ihe ize ndụ dị ukwuu nke ọnya afọ ma ọ bụ nsogbu eriri afọ mgbe e mesịrị na ndụ.

Isi mmalite na nduzi ọchịchị¶

• ** American Pediatric Surgical Association (APSA) & American Academy of Pediatrics (AAP, United States):** * Usoro ọgwụgwọ nlekọta ahụike maka nchọpụta nchọpụta, nkwụghachi mmiri mmiri na-arụ ọrụ, na njikwa laparoscopic nke Hypertrophic Pyloric Stenosis *.
• ** Ụlọ Ọgwụ Ụmụaka Royal (RCH) Melbourne (Australia): *** * Ntuziaka Omume Clinical: Pyloric Stenosis (Electrolyte Targets, IV 0.9% Sodium Chloride Protocol, na Ultrasound Criteria)*.
• ** National Institute for Health and Care Excellence (NICE, United Kingdom):** Nlekọta Postnatal & Gastro-Oesophageal Reflux Disease in Children and Young People: Red Flags for Projectile and Bilious Vomiting (NG1).
• ** Ụlọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa (CDC, United States): ** Ntuziaka MMWR na Ngosipụta Ọgwụ nje Macrolide (Erythromycin na Azithromycin) na mmalite nwata na ihe ize ndụ nke Hypertrophic Pyloric Stenosis *.
• Ọha na-ahụ maka Nkụnwụ ụmụaka (SPA):* Ntuziaka na Bicarbonate tupu arụ ọrụ na chloride Normalization iji gbochie Post-Anesthetic Apnea n'ime ụmụ ọhụrụ nwere Pyloric Stenosis*.

Ntuziaka emetụtara¶

• Intussusception (telescoping bowel) na ụmụ ọhụrụ na ụmụaka
• Mgbochi afọ, hernia kpagburu, na akara mberede volvulus
• Nsi nri, nnukwu gastroenteritis, na akpịrị ịkpọ nkụ
• Nsogbu adrenal na ọgwụ mgbochi ọrịa Addison
• Ọrịa ụmụaka na ụmụ ọhụrụ CPR na ịma jijiji