Dibutuka dia bana (dia vert), dibutuka dia tshiamu tshia mitaku, ne dibutuka dia munda ('Currant Jelly' Stool)¶

Padi mabele matekete, kaayi ne lutatu (gastroesophageal reflux) udi wenzeka mu bana bapite pa 70 pa lukama badi ne makanda a mubidi mimpe kunyima kua didia, mishindu isatu mishilangane ya disama dia nsukadi ne disama dia mu difu bidi bilumbu bia dipanda dia bana mu tshimpitshimpi mudi ditantamana dia nansha mêba 2 too ne ku 6 mua kufikisha ku disama dia munda dia tshipupu, disama dia hypovolemie, anyi lufu:(1) Bigre anyi dia balume dia lime dark spinach-green) vomiting** caused from Intestinal Malrotation with Midgut Volvulus, (2) Forceful, non-bilious "projectile" vomiting in a 2-to--8-week-old-old muana wa mbingu 2 too ne ku 8 difumina ku Hypertrophic Pyloric Stenosis (HPS), ne (3) Mu tshimpitshimpi, mavuala a mbila adi kaayi mua kusankisha padi muana wa ngondo 3 too ne ku 36 ukoka binu biende ku tshiadi, ulua mutoke/mutekete pankatshi pa bipupu, ne upita mashi ne mutoyi ("jelly wa cassis") bifumina ku Ileocolic Intussusception.

Shi muanebe muele mayi mafike nansha musangu umo, ulua mutekete, kayi witaba, anyi mutoke, muikale ne difu dikole anyi diuwule tente, anyi mulekele kupatula diapers miume, ubikile ku nimero wa lupitadi lua muaba unudi (911 mu États-Unis ne mu Canada, 112 mu matunga masanga a ku Mputu, 999 mu Royaume-Uni) anyi tangila tshilaminu tshietu tshia matunga masanga tshia nomba ya tshimpitshimpi diakamue. Bua malu a tshimpitshimpi a luya, bala kapia kakole ka muana ne disama dia tshimpitshimpi. Londa mikenji ya dipanda dia bana idi kuinshi eku.

Enza nunku mpindieu¶

1. Ikala ne tshintu tshionso tshidi tshikenka tshia lime-vert anyi tshia forest-vert tshifiike (bilious) kuela nsukadi mu muana mutekete bu tshilumbu tshia lukasa tshia dipanda tshidi mua kunyanga muoyo (Midgut Volvulus) too ne padibu baleja ne: ki mmuomu to: Dituta dia mu tshifu didi ditoke, ditoke anyi dia jaune wa manteka (difumina ku colostrum, mafuta a mabele anyi aside wa mu tshifu). Bile wa vert udi ubuela mu tshifu mu tshitupa tshibidi tshia duodenum (Ampulla of Vater). Shi bile wa tshisuku udi upatuka mukana mua muana, mala adi makanga muinshi mua tshina tshia bile, ne mala onso makese adi mua kuikala manyanguke 360 degrés pabuipi ne mashi ende (superior mesenteric artery volvulus), udi utangila disama dia munda mua 2 too ne ku 6 meba.
2. Angata foto mutoke wa tshiamu tshia mitaku (pa tshilamba tshitoka/tshilamba tshia tshipupu) ne tshilamba tshia kulala, ne ulue ne tshilamba tshia kulala tshidi ne bukoya mu tshibombi tshia Ziploc ku Tshibambalu tshia malu a mpukapuka: Muinshi mua miendu ya mu lupitadi idi ikenka, uleje munganga wa malu a mpukapuka foto wa **mutoyi wa bile wa emeraude/epinard-green anyi udi ne tshintu tshikunze (tshilamba tshikunze) jelly") stool udi upita mêba a bungi a dienza dia triage ne udi usaka bua kuya kutangila munganga diakamue.
3. LEKELA biakudia bionso bia ku mishiku (NPO , kakuyi mabele, mabele, mayi, anyi bintu bia electrolyte) diakamue paudi uya ku Tshibambalu tshia malu a mpukapuka: Bikala muana webe ne mala adi manyanguke (volvulus), mala a teleskopike (intussusception), anyi tshifu tshikanga (pyloric stenosis].
4. Lama muana udi utua mikemu ku luseke luabu (Lateral Recovery Position) anyi mukuate mululame pa dikaya diebe padibu bakuambula: Kuladi muana udi utua mikemu anyi udi ne disama dia nsukadi pa mukolo muaba udi aside anyi bile bia mu tshifu bidi bipatuka bidi mua kupuekeshibua mu mushipa wa lupepele to.
5. Manya "Buteyi bua dipanga dia mutoyi" bua Intussusception: Pankatshi pa dibunda dia mbila (didi dienzeka kunyima kua minite 15 too ne ku 20 padi mavuala a peristaltic afina mala a teleskope), muana udi ne intussusception utu misangu ya bungi upatula endorphines endogènes ne ulua mupole, mutoke, ne mêsu a makala floppy/somnolent. Kuena ne bua kuela meji ne: tshitupa tshia minite 15 etshi tshidi tshileja ne: "muana udi udiumvua bimpe ne udi ulala tulu", ntshimanyinu tshia dikuma dia mijilu ya mu tshifu ne tshipupu tshia mu lungenyi.
6. Ndaku buludiludi ku lupitadi lua bana anyi ku tshibambalu tshia malu a mpukapuka tshia bana tshidi ne ultrasound wa bana ne dipanda dia bana 24/7: Dimanya ne dilongolola dia stenosis pylorique, intussusception (pneumatic/hydrostatic enema reduction), ne midgut volvulus (Ladd procedure) udi ulomba baminganga ba bana ne baminganga ba dipanda; kuya buludiludi ku nzubu wa luondapu lua bana kudi kusungila mêba 2 a dituma dia ambulanse munkatshi mua lupitadi.

Mutshi wa dipangadika: disama dia muana ne disama dia mu difu dikole¶

Ingidija tshimfuanyi etshi tshia malu a luondapu bua kusunguluja disama dia muana mutekete ne bilumbu bisatu binene bia dipanda dia bana:

flowchart TD
    Start["Muana mutekete anyi muana mutekete udi ne disama dia nsukadi dia bukole, nsukadi ya vert, anyi dia mbila ya mu difu"] --> ColorCheck{"1. Tshintu tshidi ne dikala kayi?"}
    ColorCheck -->|"MUTU WA LIME-GREEN OR DARK SPINACH-GREEN (Bilious)<br/>(Nansha tshitupa tshimue mu muana mutekete)"| Volvulus["CATEGORY 1 URGICAL EMERGENCE: SUSPECT MIDGUT VOLVULUS<br/>1. Lekela kudia bionso (NPO) -> Lama muana ku luseke<br/>2. Foto wa tshisuku tshia vert -> Ndaku ku Pediatric ED DIAMUE<br/>3. Bidi bikengela dilengeja dia mu tshiadi + GI wa kuulu wa lukasa / Ultrason ne dipanda dia Ladd"]
    ColorCheck -->|"MUTOKE / MUTU / MUTOKE / MUTOKE (Kayi ne Bilious)"| PatternCheck{"2. Ntshinyi tshidi tshilele tshia disama ne bidimu bia muana?"}
    PatternCheck -->|"Bidimu 2 too ne ku 8:<br/>Dibutuka dia 'Projectile' dia bukole Dituta mu tshitanda tshia bana panyima pa didia<br/>+ Muana udi udila diakamue bua kudia kabidi ('Muntu udi ne nzala')"| Pyloric["KUJIKIJA NE: KUDI KUENZA MU MUTU (HPS)<br/>1. Lekela kudia -> Ndaku ku ED wa bana lelu<br/>2. Tangila ni udi ne dipanga dia mayi + Hypochloremic Hypokalemic Metabolic Alkalosis<br/>3. Ultrasound udi ujadika 'Olive' -> IV Saline/Potassium udi ne tshia kuikala kumpala kua Pyloromyotomy"]
    PatternCheck -->|"Bidimu 3 too ne ku bidimu 3:<br/>Kuela mbila mu tshimpitshimpi mu minite 15-20 yonso Kukoka binu too ne ku tshiadi<br/>+ Mutoke/Mutshioke pankatshi pa bikondo +/- Tshibasa tshikunze tshia 'Currant Jelly'"| Intuss["KUJIKIJA KUDI BUALU BUA ILEOCOLIC<br/>1. Lekela kudia (NPO) -> Foto ya tshiamu tshia mitaku -> Ndaku ku Pediatric ED DIAMUE<br/>2. Ultrason udi uleja 'Tshipatshila / Tshimanyinu tshia Donut'<br/>3. Badi baondapibua kakuyi dipanda ku diambuluisha dia lupepele lua lukasa anyi dipuekesha dia enema wa mukele"]
    PatternCheck -->|"Mabele makese adi kaayi ne lutatu kunyima kua dipuekesha,<br/>Divulangana dia kilo dia disanka ('Muntu wa disanka')"| Reflux["BENIGN PHYSIOLOGICAL GASTROESOPHAGEAL REFLUX (GER)<br/>Ikala mululame 20-30 min kunyima kua didia; pace bottle feeds; dilonda dia pa tshibidilu dia bana"]

Tshitupa 1: Tshilejelu tshinene tshia difuanyikija dia masama 4 a bana batekete¶

Baledi ne baminganga badi mua kusunguluja disama dia reflux didi kadiyi ne njiwu ne dia malu asatu a tshimpitshimpi mu tusunsa 60 pa kutangila Age Window, Vomit Color, Appetite After Vomiting, ne Pain/Stool Pattern:

Tshitupa 2: Dibuela dia muinshi mua buloba 1, Bilious (Green) Vomiting ne Midgut Volvulus (The 6-Hour Clock)¶

Bua tshinyi munganga yonso wa bana udi pa buloba udi ushiya bintu bionso ne unyema uya ku tshibambalu tshia malu a mpukapuka padi muana mulela anyi muana mutekete wela mayi a matamba?

1. Anatomi wa Malrotation ne Midgut Volvulus¶

Mu tshikondo tshia dikola dia muana (mu mbingu 6 too ne ku 10 ya dimita), mala a muana adi enda akola adi anyunguluka 270 degrés mu mushindu udi kauyi umvuangana ne dîba ne adi alamakaja bimpe pa tshintu tshinene tshidi tshilamakaja (the mesentery) ku mutu kua difu dia dia bakaji (Ligament of Treitz) kuinshi kua difu dia dia balume (cecum). - Mu 1 pa 500 ya bana baledibua ne muoyo (Intestinal Malrotation): Dishintuluka edi didi dijika munkatshi mua njila. Pamutu pa kuikala mushindame pa tshishimikidi tshinene, tshishindame, mala makese onso adi alenga ku tshimanu tshia panyima pa difu pa mutshi mutekete bu wa dibeji udi ne mushipa wa Superior Mesenteric Artery (SMA) ne Vein (SMV), eku bipese bia nshinga bidi kabiyi biakane (Ladd's bands) kusabuka pa mutu pa duodenum. - Twist (Midgut Volvulus): Dîba kayi dionso, misangu ya bungi mu mbingu 4 ya kumpala ya muoyo, mala makese adi kaayi makole adi mua kunyunguluka mu luseke lua dîba bu tshilamba tshikosa (360 to 720 degrees) munyunguluke tshimuma tshikese tshia mishipa. - Bipupu bibidi bia musangu umua: 1. Duodenal Blockade (Bilious Vomiting): Tshilamba tshidi tshinyunguluka tshidi tshikuata duodenum mukanga anu kuinshi kua njila wa bile, tshienzeja bile wa mu tshifu udi ne mubidi wa vert mutoke bua kupingana mu tshifu ne kupatuka mukana mua muana. 2. Dishipa dia tshifu (Total Midgut Necrosis): Dikoseka didi dishipa Mushipa wa Mesenteric Superior ne Arterie udi ufila 100 pa lukama wa mala makese (jejunum and ileum) ne tshitupa tshia mala manene. Bikalabi kabiyi biunzulula ku diambuluisha dia dipanda (Ladd Procedure) mu mêba 2 too ne ku 6, mala makese onso a muana adi afua, ne bidi bifikisha ku lufu lua septic shock anyi Short Bowel Syndrome wa matuku onso a muoyo wende udi ulomba bua kumuela biakudia bia kashidi mu mushipa (TPN).

2. Bua tshinyi Volvulus wa kumpala udi mua kushima baledi ne baminganga (The Flat-Belly Trap)¶

• Mu mêba 1 anyi 4 a kumpala a volvulus wa mu tshifu tshia munkatshi, dikanga didi dikola mu duodenum, nunku difu dia muana ditu misangu ya bungi dibalakane ne ditekete (kadiyi divula), ne muana udi mua kumueneka bimpe pankatshi pa bikondo bia dibutuka dia matamba.
• Kuindila tshifu tshikole, tshikole anyi tshifu tshidi ne mashi nkuindila mutantshi mule: Difu dikole, diunzuluke, dishintuluka dia dikoba dia tshifu dikunze/dia violet, tachycardie, ne tshifu tshiuwule tente ne mashi bidi biumvuija ne: mala mmatuadije kale kufua. Tshitupa tshimue tshia disama dia tshiadi tshia mu muana tshidi tshikengela bua kuya nende diakamue mu tshimpitshimpi.

Tshitupa 3: Dibuela dia muinshi mua buloba 2, Hypertrophic Pyloric Stenosis (HPS ne dibutuka dia bintu)¶

Bidi bikuata 2 too ne ku 3,5 pa bana 1000, misangu ya bungi bana ba kumpala badi ne bidimu pankatshi pa mbingu 3 ne 6 (ne njiwu mikole padibu bapeta manga a macrolide bu mudi erythromycine anyi azithromycine mu mbingu ibidi ya kumpala ya muoyo), Hypertrophic Stenosis (HPS) i dikola dia tshiamu tshia mitaku tshidi tshinyunguluke ku dipatuka dia tshifu (the pyloric sphincter).

1. Mushindu kayi wa kujingulula disama dia projectile pyloric stenosis pa kumbusha reflux wa pa tshibidilu anyi dibenga kuitaba dia formule¶

1. Divulangana dia "Bukole ne ntanta" mu matuku 3 too ne ku 7:
2. Misangu ya bungi bitu bituadija pabuipi ne mbingu isatu bimueneka bu dibutuka dia bukole, pashishe bidi bienda bikola lukasa too ne padi biakudia bionso bijika ne dipatuka dia bu mudi tshina tshia mâyi dia mabele matoke, mafuba, adi ne mupuya mubi (misangu mikuabu adi ne tutotshi tukese tua "kafe-mufuba" tua mu tshisuku tshikole, **mushindu wa bile) udi **mutoke) ututa 30 too ne ku 90 santimetre (1 too ne ku 3 feet) kupita pa minu ya muana.
3. Nsombelu wa kale wa "Muntu udi ne nzala":
4. Bishilangane na muana udi ne disama dia mu tshifu anyi disama dia mu tshifu (udi umvua tshiji ne ubenga kunua mulondo), muana udi ne disama dia pyloric stenosis dia kumpala udi ne buongo ne mala adi ne makanda a mubidi mimpe adi anu afua ne nzala bualu biakudia kabiena mua kupita ku tshiibi tshia tshifu tshidi tshikole to. Diakamue padi muana ujikija kuela mbila, badi bakuela miji bikole ku tshiadi tshiebe ne badila ne tshiji tshikole bua kudia kabidi.
5. The Visible "Golf-Ball Peristaltic Wave" Panyima pa Didia:
6. Wewe mubulule difu dia muanebe muinshi mua muendu diakamue panyima pa yeye mumane kunua mabele (kumpala kua yeye kuela nsukadi), udi mua kumona misangu ya bungi mutoyi udi wenda umueneka bu mupimbu wa golf wenda unyunguluka muinshi mua dikoba kumbukila ku mifuba ya ku dia bakaji too ne ku difu dia dia balume dia pankatshi padi difu dienda dikuma ku pylorus udi mukanga.

2. Mukenji wa mushinga mukole wa mu lupitadi: Bua tshinyi Pyloric Stenosis udi munganga wa dibisha kumpala kua kuluaye mupanda¶

Baledi batu misangu ya bungi bakema padi munganga wamba ne: "Tudi bapete disama dia Pyloric Stenosis ku ultrason mu minite 10, kadi katuakuya ne muanebe mu nzubu wa dipanda munkatshi mua mêba 12 anyi 24 to." Mona bua tshinyi ditanta edi didi disungila muoyo wa muanebe: - Hypochloremic, Hypokalemic Metabolic Alkalosis: Dîba dionso didi muana wenu wela aside mu tshifu tshikezuke (\(\text{HCl}\)), mubidi wende udi ujimija bungi bua bungi bua Hydrogène ions (\(\text{H}^+\)), **Chloride (\(\text{L^**), {\)}sodium (\(\text{Na}^+\)), ne mayi. Bua kulama mayi, mifuba ya muana itu ipatula Potassium (\(\text{K}^+\)) wa mushinga mukole ne ilama Bicarbonate (\(\text{HCO}_3^-\)), bienza bua mashi a muana ikale ne alcaline (Metabolic Alkalosis). - Njiwu ya disama dia apnée panyima pa dienza dia anesthesie: Bualu bicarbonate wa bungi mu mashi (\(\text{HCO}_3^- > 30\text{ mEq/L}\)) udi udinga tshitupa tshia mu lungenyi tshia muana bua kupuyakana (bua kulama acide \(\text{CO}_2\)), udi uteka muana udi kayi ne disama dia kansere ka mu mubidi ne disama dia tshiadi anesthesie udi ukebesha dipanga dia mupuya dia panyima pa dipanda (dilekela dia kupuyakana panyima pa dipanda) ne disama dia mutshima didi difumina ku dipanga dia potassium. - Mukenji wa bukubi: Tshisumbu tshia baminganga tshia bana tshidi tshianji kufila mêba 12 too ne ku 24 a mu mishipa 0.9% Normal Saline + Dextrose + Potassium Chloride too ne padi chloride wa mu mashi ufika ku \(> 100\text{ mEq/L}\), bicarbonate udi \(< 28\text{ mEq/L}\), ne muana udi wenza diapers miume, ne anu pashishe ke udi wenza 15-minute Laparoscopic Ramstedt Pyloromyotomy (kupandulula tshitupa tshia pambelu tshia mu tshifu bua kashidi tshiunzulula tshifu ne bana kudia bimpa mu meba makese kunyima kua dipanda).

Tshitupa 4: Dibuela dia muinshi mua buloba 3, Intussusception (Telescope Bowel ne 'Currant Jelly' Stool)¶

Intussusception ke #1 udi ukebesha dipanga dia mala mu bana batekete ne bana batyetye badi ne bidimu pankatshi pa ngondo 3 ne 3 (difika ku tshibungubungu pankatshi pa ngondo 5 ne 9**). Bidi bienzeka padi tshitupa tshia pabuipi tshia mala makese (the ileum) udi upeta ne ubuela munda mua mala manene adi pabuipi (the cecum/colon) anu bu mudi tshiamu tshia kutangila natshi bintu tshidi mua kukuluka anyi tshilamba tshidibu bashintulule tshitupa tshia munda ne pambelu.

1. Bua tshinyi intussusception udi wenzeka kunyima kua disama dia mashika, disama dia mu tshifu, anyi disama dia lymph node¶

Mu 90 pa lukama ya bana batekete (idiopathic ileocolic intussusception), disama dia tshiadi dia matuku mashale aa (adenovirus) anyi gastroenterite wa virus udi wenza bua bitupa bia lymphatique bidi munda mua tshitupa tshia ndekelu tshia ileum (Peyer's patches) bivula bu mudi tunsils tuvula. Difina dia mala dia pa tshibidilu (peristalsis) udi ukuata tshitupa tshia mashi tshidi tshiuwule (the lead point) ne udi ukoka mala makese munda mua tshifu, ukoka mijilu yende ya mashi (mesentery) mu tshilamba tshikole natshi.

2. Tshisatu tshia mu lupitadi tshia kale (Ne bua tshinyi kuena ne bua kuindila tshintu nansha tshimue)¶

Mikanda idi ilongesha mishindu isatu ya kale ya Disama dia mu difu + Tshintu tshia sosise tshidi tshimueneka + Tshintu tshikunze tshia "Currant Jelly", kadi bana batue ku 30 pa lukama badi ne bimanyinu bionso bisatu ebi padibu bafika ku Tshibambalu tshia malu a mpukapuka:

1. Tshimanyinu 1 (tshidi mu 85-90%): Tshimpitshimpi, Paroxysmal "Knee-to-Chest" Screaming Waves Every 15 to 20 Minute:
2. Muana uvua unaya anyi mulale udi wela mbila ya kanyinganyinga, udi ulua mutoke, udi utua tuishi, ne udi ukoka binu bionso bibidi bikole ku difu diende munkatshi mua minite 2 too ne ku 5 padi dikokangana dia peristaltique difina mala adibu baleje ku teleskope.
3. Pashishe dikokangana didi dijika, ne muana udi ulekela kudila diakamue.
4. Tshimanyinu 2 (Tshilumbu tshia diagnostic tshidi ne njiwu mikole): Dipanga dia lungenyi dia panyima pa disama dia tshiadi / Dipanga dia bukole dia "Stroke-Like":
5. Mu tshitupa tshia minite 15 too ne ku 20 pankatshi pa disama dia kanyinganyinga, mijilu ya mu tshifu idi mifina idi ipatula opioïde ne bintu bidi bienza bua muana ikale kayi ne tshisumi, mêsu a lumuenu, mutoke, kayi ne tulu, anyi kayi ne tshiji tshikole. Mu bulelela, 10 too ne ku 15 pa lukama ya bana badi ne disama dia intussusception badi ne dipanga dia lungenyi dikole ne dishintuluka dia lungenyi kakuyi didila dia patoke, ku ntuadijilu bimueneka bu sepsis anyi meningitis.
6. Tshimanyinu 3 (tshimanyinu tshia ndekelu tshia disama dia mu mishipa): "Currant Jelly" Stool:
7. Padi tshitupa tshia munda tshia munda tshidi tshikuata tshikola, mashi a mu mishipa kaena mua kupatuka padi mashi a mu mishipa atungunuka ne kupompa to. Tshilamba tshia munda tshidi tshiuwule tshidi tshidila mashi a mu mishipa mafiike masambakaja ne mutoyi munene wa goblet-cell, upatula tshintu tshidi tshimueneka bu jelly wa cassis mufiike anyi marmelade wa raspberry.
8. MUYUKI WA MUSHINDU: "Currant jelly" tshintu tshia munda tshidi tshileja ne: mucosa wa mala udi kale muwule tente ne udi upatuka mashi. Ndaku ku Pediatric ED mu tshikondo tshia mbila ya tshimpitshimpi ya ku binu too ne ku tshiadi + dipanga dia lungenyi/diela dia nsukadi, mêba a bungi kumpala kua tshintu tshidi ne mashi kumueneka.

3. Mushindu kayi udi baminganga balongolola disama dia tshiadi kakuyi dipanda (The Air or Saline Enema)¶

Wewe mulue ne muanebe ku tshibambalu tshia malu a mpukapuka a bana kumpala kua dîba (mu mêba 12 anyi 24 a kumpala, kumpala kua dibutuka dia mala): - Diagnostic Ultrasound (100% Radiation-Free): Bidi biangata minite 5 ne bileja "Tshimanyinu tshia tshipatshila" / "Tshimanyinu tshia donut" / "Tshimanyinu tshia dîsu dia ngombe" (bipese bia munda mua mala) bidi kabiyi biumvuika. - Dikepesha dia enema wa tshiamu tshia mitaku (mu lupepele) anyi tshia mâyi (mu mâyi a mu mâyi) tshidi katshiyi tshia dipanda: Mu 85 too ne ku 90 pa lukama ya bilumbu, kakuena dipanda nansha dikese didi dikengedibua to. Mu bulombodi bwa ultrason anyi fluoroscopie, munganga wa bana udi uteka tshiamu tshia katetere tshipepele mu tshifu tshia munda ne ubueja tshipepele tshia luya (\(\le 120\text{ mmHg}\)) anyi saline wa kapia udi ukokesha bitekete bitekete ileum udibu baleje ku teleskope panyima pa tshifu mu minite 3, ufila disulakana dia muana mu tshitupa tshîpi. (Dimanya: mu bana 5 too ne ku 10 pa lukama, mala adi mua kupingana mu meba 24 too ne 48 a kumpala padi tshitupa tshia Peyer tshitshidi tshiuwule, nunku ikala utangila bimpe panyima pa dipatuka mu lupitadi bua kumona ni kudi dipingana dia disama dia cyclique).

Tshitupa 5: Bintu bikwabo bidi mua kunyanga muoyo bia bana batekete ne diela dia mbila (Incarcerated Inguinal Hernia, Testicular Torsion, ne Cow's Milk Protein Enterocolitis / FPIES)¶

Dîba dionso didi muana anyi muana mutekete ulua ne kudila kua tshimpitshimpi ne kuela nsukadi mikole, baminganga ba mu lupitadi lua bana batu misangu yonso bumbusha tshilamba tshia kulala bua kutangila ni malu abidi a pambelu a mubidi ne tshipupu tshimue tshikole tshia dipanga dia biakudia bidi bifuanangane menemene ne intussusception ne pyloric stenosis:

1. Inguinal Hernie Incarcerated or Strangulated (Always Check the Diaper Crease)¶

Bu mudi 1 too ne ku 5 pa lukama ya bana badi balela mu tshikondo tshijima ne too ne ku 10 too ne ku 30 pa lukama ya bana badi balela kumpala kua dîba (misangu 8 mipite bungi kudi bana ba balume, nansha mudibi kabidi bimueneka kudi bana ba bakaji mudi tshifu tshidi mua kubuela mu tshina tshia Nuck), inguinal hernia udi wenzeka padi tshitupa tshia mala makese tshipita mu tshina tshidi katshiyi tshikanga (patent processus vaginalis) mu tshitupa tshia mu nshingu anyi mu tshifu. - Tshidi baledi bamona padi diaper dipatuka: - Tshitupa tshikole, tshikole, tshidi katshiyi mua kufina anyi tshidi tshivula mu tshiadi (anyi ku luseke lumue lua tshifu/tshiamu) tshidi katshiyi tshinyanguka padi muana ulekela kudila, misangu ya bungi tshidi tshilua tshikunze, tshikunze, anyi tshimpe menemene padibu batshilenga. - Bu mudi tshitupa tshia mala tshidi tshikanga tshishiki munda mua tshijengu tshikole tshia mu tshiadi, muana udi upeta dila dia paroxysmal, dikola dia difu, ne dipuekesha dia bukole (didi dilua dikala dia vert bilious). - Tshienzedi tshia lukasa: - KUTEKI bua kuela tshitupa tshikole, tshikunze anyi tshitekete tshia mu tshiadi munda muebe kumbelu (risk of rupturing ischemic bowel or reducing dead bowel en masse). Ndaku diakamue ku tshibambalu tshia malu a mpukapuka a bana bua munganga wa bana enze mudimu wa dilengeja dia bana (taxis) mu tshikondo tshia mêba 6 kumpala kua disama dia mala anyi dia tshifu.

2. Dinyanguka dia tshifu tshia muana mutekete anyi tshia muana mutekete¶

Mu bana ba balume, dikoseka dia muonji wa mabele (testicular torsion) udi ufila tshiji tshikole tshia mu tshifu, tshipupu tshikole, ne mbila ya tshimpitshimpi padi muana ukoka maulu ende mulu, bidi bipepele bua kuela meji ne: disama dia colic anyi dia intussusception pikala tshilamba tshia kulala tshishala tshilamakaja. - Tshikebelu tshia tshifu tshia tshiadi tshidi tshilomba bua kumbusha diaper: Misangu yonso ikala utangila nseke yonso ibidi ya tshifu padi muana udila anyi utua tshiadi. Shi luseke lumue lua tshifu ludi luvula, lukole, luenda lukola, anyi lutoke-bule, ndaku lukasa ku tshibambalu tshia malu a mpukapuka (tshilumbu tshia tshifu tshidi tshipueka lukasa kunyima kua mêba 4 anyi 6 a ischémie).

3. Disama dia Enterocolitis didi difumina ku proteyine ya biakudia (FPIES) vs. Dipangisha dia kupanda¶

Netuambe tshinyi bikala muana wa ngondo 2 too ne ku 9 mutuadije kuela manyi a bungi, mêba 1 anyi 4 panyima pa yeye mumane kuteta biakudia bipiabipia (pa tshibidilu mabele a ngombe, soya, oats, cereale wa mpunga, dii, anyi banana) ne lukasa luonso ulua mutekete, mutoke, mutoke bu nsukadi, ne hypothermie? - Acute FPIES: Tshienzedi tshia disama dia tshifu tshidi katshiyi tshienza kudi selile ya IgE tshidi tshikebesha dishintuluka dia bungi dia mâyi mu lumen wa tshifu (third-spacing), bienza bua 15 too ne ku 20 pa lukama ya bana batekete bikale ne tshipupu tshikole tshia hypovolemic tshidi tshimueneka bu tshia sepsis, tshia intussusception anyi tshia volvulus. - Dilombola dia malu a tshimpitshimpi: Nansha wewe wela meji ne FPIES ku biakudia bipiabipia bivuabu bapatule mêba 2 kumpala, enda ku tshibambalu tshia malu a mpukapuka diakamue. Tshikole FPIES udi ulomba lukasa mushipa wa mâyi a mukele (20 mL/kg) ne ondansetron wa mu mishipa anyi wa ku mishiku (Zofran) bua kuimanyika tshipupu tshia cytokine ne kupangisha tshipupu.

Mulongo wa dikonkonona dia kumbelu: dipanga dia mâyi mu mubidi wa muana ne bimanyinu bikunze¶

Dîba dionso didi muana utua mishiku misangu ne misangu, tangila 5 Hydration & Perfusion Markers eyi kumpala ne padibu baya nende ku lupitadi:

• Bala diapers miume mu meba 12 too ne ku 24: Muana udi ne mayi muinshi mua ngondo 6 udi ne tshia kupatula diapers miume mikole 6 mu meba 24 (diapers 1 miume mu meba 4 too ne ku 6). Kuenza mêba mapite pa 6 ne tshilamba tshia kulala tshiume tshia mifuba (anyi mabue a urate a orje/pink mu tshilamba tshia kulala) kudi kuleja dipanga dia mâyi mu mubidi.
• Tangila Fontanelle wa kumpala ("Muaba mutekete" pa mutu): Paudi umukuata bimpe mu muaba wa kusomba mululame, muaba mutekete udi bu diamant udi pa mutu pa mutu wa muana udi ne bua kuikala mupepele ne mutekete. Tshitupa tshitekete tshidi tshibuikila munda menemene tshidi tshileja dijimija dia bungi bua mâyi dia munkatshi anyi dia bungi (padi fontanelle mukole, mubumbakane udi uleja dikola dia tension wa munda mua mutu/meningitis).
• Tangila binsonji, luya lua mukana, ne tshimuenekelu tshia mêsu: Ela munu mutoke munda mua ditama dia muana: udi ne bua kuikala mutoke ne mate maume. Ludimi luume, lulamakaja, luume, udila kayi ne binsonji bia mâyi, ne mêsu mafiike, adi ne tshijengu bidi bileja \(\ge 5\text{ to }10\%\) dipanga dia mâyi mu mubidi.
• Teta tshia munkatshi ne tshia ku mpenga kua kapilare (The 2-Second Sternum Press): Fina munu webe bitekete bitekete munkatshi mua tshiadi tshia muana (sternum) anyi dikasa dinene mu tusunsa 3 too ne padi dikoba dilua ditoke, pashishe ulekela: dikala dia rose didi ne bua kupingana mu muinshi mua tusunsa 2. Tshikondo tshia kuwuja tshia 3 sekonde anyi kupita apu, anyi bitupa bia mubidi bidi ne mabala, bidi bileja ne: tshipupu tshia hypovolemic tshidi tshifutshibue.
• Tangila mushindu wa kupuyakana: Kupuyakana lukasa, ne mupuya mukole (Kussmaul respirations) bileja disama dikole dia acidose metabolique didi difumina ku dipanga dia mâyi mu mubidi anyi ku ischémie wa mu mala, kadi dipuekesha dia mupuya dia patupu didi mua kuenzeka mu alkalose metabolique mikole (pyloric stenosis).

Nkonko itubu bela misangu ya bungi¶

Ndishilangana kayi didi pankatshi pa nsukadi ya jaune ne nsukadi ya vert (bilious) mu muana?¶

Mutoyi wa jaune mutoke anyi wa manteka udi ufumina ku mafuta a mabele, ku colostrum, anyi ku mâyi a mu tshifu adi pa mutu pa njila wa bile ne utu utamba kuenzeka mu reflux muimpe anyi mu bipupu bia mu tshifu. Mutoyi wa vert lime, vert highlighter, anyi vert forêt mufiike (bilious) udi ne bile wa tshifu udi upatuka mu mala adi kuinshi kua tshifu mu tshitupa tshibidi tshia duodenum. Shi bile wa tshisuku udi upatuka mukana mua muana, bidi biumvuija ne: mala adi makanga kuinshi kua njila wa bile, bualu budi ne njiwu mikole budi bufumina ku Intestinal Malrotation ne Midgut Volvulus, mudi mala makese onso anyanguka mu mushipa wende munene ne mua kufua mu mêba 2 anyi 6. Disama dionso dia matamba mu muana mutekete didi dilomba bua kuya diakamue ku nzubu wa luondapu lua lukasa.

Mmunyi mundi mua kumanya dishilangana pankatshi pa dipuekesha dia mate dia muana ne dibutuka dia tshintu tshidi tshipatuka ku disama dia pyloric stenosis?¶

Reflux physiologique wa pa tshibidilu ("kuela mate ne disanka") udi wenzeka kakuyi lutatu padiye utua mate anyi diakamue panyima pa disama dia nsukadi, udi upueka bitekete bitekete ku tshibeku anyi ku tshiadi tshia muana, ne muana udi ushala mupole ne udi wenda uvula kilo bitekete bitekete. Hypertrophic pyloric stenosis utu utuadija pankatshi pa mbingu 2 ne 8 ne udi ukebesha disama dia tshiadi didi dienda dikola, mudi didia dionso dia mabele matoke adi kaayi ne bile dipatuka mu tshitupa tshia 30 too ne ku 90 santimetre (1 anyi 3 feet) kule ne mukana mua muana, pashishe diakamue muana udi udia kabidi ne tshiji tshikole (" udi ne nzala"), dijimija dia kilo, ne dipuekesha dia diapers miume.

Bua tshinyi muana udi ne disama dia intussusception udi umueneka bu udi ulala tulu anyi wenza malu anu bu muntu yonso munkatshi mua minite 15 pankatshi pa diela mbila?¶

Mu intussusception, tshitupa tshimue tshia mala tshidi tshibuela munda mua tshikuabu anu bu tshiamu tshia teleskope. Mu minite yonso 15 to ne 20, tshipepele tshia pa tshibidilu tshia dikokangana dia misunyi ya mu mala (peristalsis) tshidi tshifina mala a munda adi makuate ne miji ya mashi idi mikuate, bienza minite 2 anyi 5 ya disama dikole dia colique mudi muana wela mbila ne ukoka binu biende bionso bibidi ku tshiadi. Padi mutoyi wa peristaltique ulekela, difina dia tshisumi didi dijika ne mala adi mafina adi apatula bungi bua bungi bua opioïdes (endorphines) ne bimanyinu bia autonomie bidi bienza bua muana amueneke mupuwe, mutoke, mutshioke anyi mutekete too ne padi dikokangana dikuabu difika kunyima kua minite 15.

Muana udi ne disama dia intussusception anyi pyloric stenosis udi misangu yonso dijinga ne dipanda dinene dia difu anyi?¶

Tòo. Bua disama dia ileocolic intussusception didi dikuata kumpala kua dibutuka dia mala, bana 85 too ne ku 90 pa lukama badi baondapibua kabayi babapanda nansha kakese ku diambuluisha dia 5-minute ultrasound- anyi X-ray-guided Air anyi Saline Enema mu nzubu wa radiologie, udi upingaja mala a teleskope bitekete bitekete pa muaba wawu. Bua hypertrophic pyloric stenosis, dîba didi mâyi a mu mishipa alongolola dipanga dia mâyi mu muana ne electrolytes mu mêba 12 anyi 24, baminganga badi benza dipanda dia pyloromyotomy laparoscopique didi kadiyi dinyanguka bikole ku diambuluisha dia tusoso tukese tua 3-millimetre; dipanda didi diangata minite 15 anyi 20, ne bana ba bungi batu batuadija kunua mabele mu mêba 4 anyi 6 ne baya kumbelu dituku didi dilonda.

Miaba mifumina¶

• Tshisumbu tshia bena Amerike tshia dipanda dia bana (APSA) & Tshilongelu tshia malu a bana tshia mu Amerike (AAP, Tshitupa tshia malu a dipanda): Mibelu ya mudimu wa luondapu bua kukonkonona disama dia bile mu muana wa muana (Malrotation ne Midgut Volvulus), Bipatshila bia dilengeja dia disama dia tshiadi tshia hypertrophique, ne dipuekesha dia disama dia tshiadi.
• Tshilongelu tshia Royal tshia malu a bana ne makanda a mubidi a bana (RCPCH) & National Institute for Health and Care Excellence (NICE, Royaume-Uni, Mikenji NG1 & CG84): Disama dia Gastro-Oesophageal Reflux ne bimanyinu bikunze bia dipanda bua disama dia projectile ne dia bilious vomiting mu bana batekete ne bana.
• Tshilongelu tshia bena Amerike tshia malu a nzembu (ACR): Malu adi akengela bua kuela nsukadi mu bana batekete too ne ku ngondo isatu (Mulongo wa GI wa ku mutu bua Volvulus vs. Ultrasound bua Pyloric Stenosis ne Intussusception).
• Bulongolodi bua makanda a mubidi pa buloba bujima (WHO): Mukanda wa mu tshibombi wa dilama dia bana mu lupitadi: Mikenji ya dilama dia masama a bana ne a tshifu tshikole.

Malu adi apetangana¶

• Disama dia botulisme dia bana (disama dia 'muana udi kayi ne makanda'), didila ditekete, ne dikala dia buitshi
• Kapia kakole ka muana ne disama dia tshimpitshimpi
• Kapia ka buana ka matuku a bungi (matuku 5+), disama dia Kawasaki, ne bipupu bia bana
• Bateri wa buto ne tshiamu tshia neodymium tshia bukole bua bungi kudi bana
• Muana udi udia tshintu tshia ku babende: makuta a bingoma, bintu bia nsongo, ne njila wa luya vs. triage
• Nomba ya njiwu bilondeshile ditunga