Te Intussusception (Telescoping Bowel) i roto i nga Kohungahunga me nga Kohungahunga: Ko te Tutuu Turi-ki-Uuma te hamama me te Tire Currant.¶

Ko te Intussusception te take tino nui o ** te aukati whekau** i roto i nga kohungahunga me nga kohungahunga i waenga i te 3 marama me te 36 marama te pakeke: he mate ohorere i roto i te puku ka mate tetahi waahanga o te whekau (tata tonu ko te ileum mutunga o te whekau iti) ka paheke me te takai i roto i te waahanga o te taha o raro o te awa (ko te karu karekau e toro ana) mesentery ki roto i te mowhiti piri. I te wa e pupuhi ana te pakitara o te whekau kua mau, ka hoki te rere o te toto ki runga, ka werohia te tohanga toto, ka puta he huringa tino kino o te hamama paroxysmal ohorere, e kore e taea te whakamarie, ka kumea e te tamaiti nga turi e rua ki te uma ia 15 ki te 20 meneti, ka taurite ki te wa o te ngoikoretanga, paereerie ** whai muri mai ko te ruaki me te whero pouri, ko te hūpē kua konatunatua ** "tiēre currant" kumete. Mena ka whakaatu te kohungahunga, te tamaiti nohinohi ranei i te tangi ohorere, ka kumea ona turi ki te kopu, ka tino mokemoke, ka uaua ranei ki te oho i waenga i nga wahanga, ka ruaki i te papa kaakaariki, ka tuku toto ranei ki tana kope, waea atu ki to rohe. tau ohorere tonu. I a koe e tatari ana ki te kawe waka, arotakehia nga aratohu e pa ana te aukati i te whekau, te strangulated hernia, me te volvulus, appendicitis me te mamae o te taha taha matau o raro, a te paihana kai, te gastroenteritis, me te matewai.

Na te mea kei te ora tonu te pakitara whekau i roto i te whakawhanautanga wawe, ** neke atu i te 85 ki te 90 paiheneti** o nga tamariki e rongoa wawetia ana i te hohipera me te reo irirangi tamariki ka taea te whakahoki marie i o ratau whekau telescoped ki te waahi i roto i nga meneti ma te whakamahi i te ** ultrasound-a-ranei i te fluoroscopy-arahi pneumatic (hau), hydrostatic ranei (saline/contrast pokanga) tino karo. Heoi ano, ko te tatari ki te kainga kia puta mai te "tiereti currant stool" (he tohu tomuri o te necrosis mucosal) ka taea e te whekau kua notia te poka, ka mate te peritonitis me te ru septic.

Mahia tenei inaianei¶

1. Haere tonu ki te tari whawhati tata o te hohipera, waea atu ranei ki to nama whawhati tata o te rohe. Waea 911 i Amerika me Kanata, 112 puta noa i te Kotahitanga o Europi, 999 i te United Kingdom, 000 i Ahitereiria, tirohia ranei to maatau rarangi ingoa o tau ohorere. Mena ka taea, haere tika ki te Hohipera Tamariki, ki te hohipera ranei e 24 haora te roa o te ultrasound pediatric me te radiologic enema kaha, waea atu ranei ki te waka tūroro mena kei te ngenge te tamaiti, te koma, te ngongo, te ruaki ranei i te wai matomato.
2. Kia mau te kohungahunga me te kohungahunga kia kore noa ma te waha (NPO: KORE he miraka, tauira, mirakau, wai, Pedialyte, kai totoka ranei). Kua tino aukatihia te whekau o te tamaiti, a tera pea e hiahia kia tere te whakaheke i te rangi radiologic/saline enema i raro i te whakamaaramatanga, i te pokanga ohorere ranei i raro i te rewharewha whanui. Ko te hoatu wai, kai ranei ki roto i te puku arai ka puta te ruaki, ka totoro te whekau ki runga ake i te paraka, ka nui ake te mate o te manawa o te manawa.
3. KAUA KAUA e hoatu he rongoa mamae, he rongoa mate nausea, he rongoa mate matere (loperamide/bismuth), he enemas ki te kainga ranei. Hoatu he ibuprofen, acetaminophen, ondansetron masks ranei nga tohu o te peritonitis, i te wa e ngana ana ki te whakamaarama i te whare, te glycerin laxative, te OTC enema ranei i roto i te necroscope kaore i aro turukihia.
4. Whakaritea nga wahanga tangi i runga i to waea me te whakaahua i te tauira "On-Off Switch" ki te nēhi triage. Kare i te rite ki te korikori noa, te mamae taringa ranei e tangi tonu ana te peepi mo nga haora, ka whai i te intussusception i nga ngaru whakaheke (peristalsis) o te whekau: ka haere te tamaiti mai i te takaro, i te moe ranei ki te ** ohorere, ka oma te kiri ki te 2 meneti ka oma te kiri o te uma, ka 2 meneti. ka mutu te tangi i te wa i timata ai, ka koma, ka werawera, ka ngenge mo 10 ki te 30 meneti i mua i te pa o te ngaru e whai ake nei.
5. Whakaorangia te kope o te tamaiti kua pokea ki roto i te peeke kirihou ka mauria ki te ruma ohorere. Ahakoa kaore ano kia rite te kuemu ki te toto whero kanapa, ki te "tire currant" ranei, tae atu ki te 70 ōrau o nga kope i roto i te intussusception he pai te whakamatautau mo microscopic occult blood (guaiac positive) mai i te kapoketanga venous moata o te taha o te taote whawhati tata.
6. Whakatupato wawe ki te roopu whawhati tata ki te mea he momoe te tamaiti, he pongore, he titiro kau noa ranei ("Lethargic Intussusception"). Tae atu ki te 10 ki te 20 paiheneti o nga kohungahunga, nga peptide rite-opioati me nga cytokines e tukuna ana e te whekau ischemic ka puta ** te ngoikore o te neurological hohonu, te tohu o te tohu (ploppiness) ranei,** ka puta mai nga kueku toto, he maha nga wa e arai ana nga kaimatai ki te whakatau pohehe i te peepi me te maningitis, sepsis, te hopu i muri i te ictal, me te tango i nga tarukino ohorere mena ka mahia he ultrasound puku.

Rakau whakatau: te arotake i te hamama o te kohungahunga huri noa, te ngenge, te ruaki nui, me te whakangao¶

flowchart TD
    Start["Kohungahunga, Tamariki ranei (ina koa 3 ki te 36 Marama te pakeke) Me te tangi ohorere, te ruaki, te ngenge, te kumete toto ranei"] --> GreenVomit{"Kei te ruaki te tamaiti i te wheehe kaakaariki, te kowhai-matomato ranei (Ko te Rua Pai), kei te whakaatu mai ranei i te puku kakea, i te wiri ranei?"}

    GreenVomit -->|"ĀE: TE HUMANGA TANGATA / VOLVULUS OR NECROTIC INTUSSUSCEPTION"| Emergency["HAPUNGA WHAKATAUTANGA I TE ORARAA: Waea wawe 911 / 112 / 999, NPO, IV Whakaoranga Wai me te Taapara Pediatric"]

    GreenVomit -->|"KORE: Tirohia te Paroxysmal Screaming & Lethargy Pattern"| PatternCheck{"He 2-5 meneti te roa o te tangi a te tamaiti, e toia ana ona turi ki te uma ia 15-30 meneti, te ngenge/kare i te whakamarama i waenga i nga whakaekenga, te kopu taha matau, te toto/te hūpē i roto i te kutae?"}

    PatternCheck -->|"ĀE ki TĒTAHI tohu: TE WHAKATAUTANGA TANGATA"| Ultrasound["Te Whakatairanga Te Tari Ohotata o te Hohipera: Tino NPO, Tiakina Kopa, Te Irarangi Puku i Te Roenga (Tirohia te Tohu Tohu / Bull's-Eye)"]

    PatternCheck -->|"KO: Tangi haere tonu > 3 haora i roto i te pai o te peepi < 4 marama, te ara tonu, te kuetu noa, kaore he ruaki"| OtherCheck["Aromātai mo te Infantile Colic, Hair Tourniquet, Corneal Abrasion, Otitis Media, or Incarcerated Inguinal Hernia (Tangohia te kope i nga wa katoa ki te tirotiro i te papa.)"]

    Ultrasound --> Reduction["I Whakapumautia te Intussusception Kaore he Perforation, Peritonitis ranei: IV Fluid Bolus + Radiologic Pneumatic (Air) or Hydrostatic (Saline) Enema Reduction (85-90% Success Without Surgery)"]

Pathophysiology: me pehea te karu o te whekau me te aha e werohia ana e ia ona ake toto¶

Ka puta te mate urutomo i te wa e mau ana tetahi waahanga tata o te kohanga whekau (e kiia nei ko te intussusceptum) e te ngaru o te whakahekenga whekau (peristalsis) ka panaia ki mua i roto i te lumen o te waahanga taha tata tonu o te whekau (ka kiia ko te 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. He aha nga kohungahunga 3-ki-36-marama te pakeke ka whiwhi "Idiopathic" Ileocolic Intussusception (90% o nga keehi)¶

I roto i te 90 paiheneti o nga keehi ka puta i waenga i te 3 marama me te 3 tau te pakeke (me te nui o te mate i waenga i te 5 me te 9 marama te pakeke), ka puta te whaanui ki te ileocecal valve kei te hono te whare kuiti ki te cecum whanui me te koroni piki (ileocolic intussusception). - Ko te Viral "Peyer's Patch" Keu: He aha te tamaiti hauora 7-marama-marama i ohorere ai te whakamarumaru i tona whekau? Ko te pakitara o te kohungahunga kohungahunga kei te kiki i nga papanga o te kiko lymphoid mucosal e kiia nei ko Peyer's patches. I muri tata mai i te mate huaketo rewharewha o runga (adenovirus) ranei te puku wheketere (gastroenteritis), i etahi wa ranei i roto i te 1 ki te 7 ra i muri i te horopeta tuatahi, tuarua ranei o te kano kano a-waha rotavirus, ka pupuhi nga papa o Peyer ki roto i te pakitara whekau hei patu i te huaketo. - ** He pehea te mahi o te kopuku lymph tetere hei "Tirohanga Arahi":** E pohehe ana nga ngaru riipene o te kohungahunga ko te papaki Peyer e pupuhi ana, e tetere ana mo te putunga kai, ka ngana ki te turaki whakamua ki raro i te ara kena, ka toia te pakitara katoa o te whare o te kohungahunga ki te taha tika puta noa i te rewharewha ileocecal ki te koroni.

2. Ina he "Pathologic Lead Point" te tangata hara (Tamariki < 3 months or > 3 ki te 5 tau)¶

I te wa e puta mai ai te mate urutomo ** kei waho** te matapihi matarohia 3-ki-36-marama tau (ina koa ki nga tamariki ** pakeke ake i te 3 ki te 5 tau ** ranei ** iti ake i te 3 marama**), ka hoki mai ano nga wa maha, ka rapuhia e nga kairoro he hanganga Pathologic Lead Point (PLP) kumea te whekau ki roto: - Meckel's diverticulum (te tohu arahi #1 i roto i nga tamariki, he putunga whanautanga o te whekau iti), - Henoch-Schonlein Purpura (IgA Vasculitis) ka puta he hematoma submucosal i roto i te pakitara whekau iti (te tikanga ileo-ileal intussusception; tirohia Henoch-Schonlein purpura me IgA vasculitis), - Polipi intestinal (polipi rangatahi, mate Peutz-Jeghers ranei), - ** Lymphoma intestinal (Burkitt lymphoma)** i nga tamariki pakeke ake i te 5 ki te 6 tau, - Cystic fibrosis (matotoru, meconium inspissated meconium/fecal plugs i roto i te whare haupae), **ranei **whanga whakaruaruatanga **.

3. Ko te 4-waahanga vascular strangulation cascade¶

Kia kumea te whekau o roto (intussusceptum) ki roto i te ringaringa o waho (intussuscipiens), ka toia te ahua o nga oko toto (te mesentery) ki roto, ka takai ki waenga i nga pakitara whekau e rua: 1. Wāhanga 1 - Te Arai Raima me te Venous (Haora 1 ki te 12): Na te mea he angiangi, he iti te pehanga pakitara o nga uaua me te lymphatic, ka pehia tuatahitia. Kare e taea e te toto venous te mawhiti mai i te whekau karu, ka nui te pupuhi me te pupuhi (edema) e mau ana te karu kia kore e taea te paheke ki waho. 2. Wāhanga 2 - Ko te Putau Putau Koata Te Puta + Te toto toto ("Currant Jelly"): I te pikinga o te pehanga uaua, ka ringihia e nga pūtau kapu i roto i te kohanga whekau he hūpē mātotoru i te wa e pakaru ana nga pukoro mucosal ka pakaru te toto ki roto i te lumen. Ka konatunatua ka panaia ki waho o te toka, ka puta mai tenei toto whero pouri me te hūpē gelatinous hei taunga "tiere currant". 3. Wāhanga 3 - Arterial Ischemia & Mucosal Necrosis (Haora 12 ki te 36): Ka piki ake te pupuhi ki runga ake i te toto toto, ka tapahia te hāora hou ki te pakitara whekau. 4. Wāhanga 4 - Transmural Gangrene, Perforation, & Septic Shock (Haora 24 ki te 72): Ka pakaru te pakitara o te whekau mate, ka maringi te huakita fecal ki roto i te kohao puku (peritonitis), ka puta te hypovolemic me te septic ru.

Te moohio i te intussusception vs. gastroenteritis, kohungahunga colic, me te maningitis¶

I te mea he maha nga wa e whai ana te intussusception i te mate makariri, te puku puku ranei, ka timata ki te tangi me te ruaki i mua i te puta mai o te toto ki roto i te kumete, koinei tetahi o nga mate ohorere tino pohehe i roto i nga tamariki.

Ripanga whakatairite haumanu: Intussusception vs. Viral Gastroenteritis vs. Infantile Colic vs. Incarcerated Hernia¶

Ko te Mahanga "Lethargic / Encephalopathic Infant" (He aha te ahua o te intussusception i te Meningitis, i te Whakanuia ranei)¶

Ko tetahi o nga peara haumanu tino nui i roto i te rongoa whawhati tata mo nga tamariki ko ** ki te 10 ki te 20 paiheneti o nga kohungahunga whai mahungatanga kei te mau "Painless or Lethargic Intussusception": - Ka mate te whekau o te pepi, ka tukuna e te whekau he waipuke nui o endogenous endorphins (opioid peptides) me nga cytokine inflammatory ki roto i te toto. - I roto i te pepi 5 ki te 10 marama te pakeke, ka mahi tika enei opioids endogenous ki runga i te roro penei i te horopeta o te morphine: ka tae te pepi ki roto i te ruma whawhati tata ** he kopa (hypotonic), he koma, he ngohe (he uaua ki te oho ake), he tohu, he puhoi ranei nga akonga me te manawa papaku, i etahi wa i mua i te kitenga kotahi o te kuemu toto, ka kitea ranei te tangi. - He maha nga wa ka mahia e nga taakuta nga werohanga lumbar (tapa i te tuakoi) mo te maningitis e whakapaehia ana, ka ota te mahunga CT scan mo te mahunga o te mahunga, ka tukuna ranei te naloxone mo te whakapae he paihana opioid i mua i te mohio he whekau karu te peepi. Ko nga kohungahunga katoa kua kore e whakamaramatia, kua rereke te ahua o te hinengaro, me te puama ohorere ranei me whiwhi i te ultrasound puku i te taha moenga mo te 2 meneti.

Te taatai ​​hohipera: te ultrasound "Waitohu Tohu" (98% ki te 100% tika)¶

Ka tae koe ki te tari whawhati tata, he tere, he mamae, he kore iraruraru ** Te Irarangi Pupu**:

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)

• He aha i kore ai e ranea nga hihi-X o te puku: He mea noa te X-ray puku totika ki runga ki te 25 ki te 50 paiheneti o nga keehi whakaurunga wawe. Ka tonohia nga hihi X maata mena ka whakapaehia e te taote te hau intraperitoneal kore utu (perforation) i mua i te ngana ki te whakaheke i te enema.
• He aha ta te ultrasound e korero ana ki te tohunga irirangi me te taote:
• Ka whakaū i te tohu Target / Bull's-Eye (te tikanga > 2.5 cm i roto i waho diameter i roto i te puku matau, whakaritea ki < 1.5 cm i roto i nga mate urutomo iti-whanui-ki-te-whao-iti ka whakatau noa).
• Ka tirotirohia Tae Doppler te rere o te toto ki roto i te pakitara whekau karu ka titiro mo te wai mau kei waenganui i nga mowhiti, te wai peritoneal kore utu ranei.

Te maimoatanga o te hōhipera tino: Pneumatic or Hydrostatic Enema Reduction¶

I mua i te tiimatanga o te nganatanga whakaheke, ka tukuna e te roopu whawhati tata he raina whakaroto (IV), ka tuhi i nga taiwhanga taketake, ka hoatu he bolus wai isotonic intravenous (20 mL/kg o 0.9% Normal Saline or Lactated Ringer's) ki te whakatika i te matewai mokowhiti tuatoru, ka whakaheke i te puku ki te ngongo nasogastric mena kei te ruaki te tamaiti, me te whakamohio i te tipa haumanu pediatric kia tu mai.

1. Tirohia te 3 contraindications tino ki te whakaiti enema¶

Ko te enema radiologic me **KORE ** kia mahia mena ka kitea tetahi o nga tohu e toru e whai ake nei (ka haere enei tamariki tika ki te ruma poka mo te mahi pokarotomy): 1. Pneumoperitoneum (Te hau kore i roto i te puku i runga i te hihi X): Ka tohu kua poka ke te whekau. 2. Peritonitis Haumanu: He puku maro, he rite ki te papa, he tino ngawari te puku e tohu ana i te whekau kua mate/kowha. 3. **Ko te Septic or Hypovolemic Shock e kore e tere tere ki te whakaora i te wai whakaroto tuatahi.

2. He pehea te mahi a te Enema Reduction kore-hapara (85% ki te 90% reeti angitu)¶

Mena karekau he pokai, he peritonitis ranei, ka mahia e te kairorohiko tamariki he rongoa Ileocolic Enema Reduction i roto i te huinga fluoroscopy, ultrasound ranei: - Ka makahia he ngongo ngongo ngohengohe ki roto i te toka o te tamaiti, ka whakapirihia nga reke hei hanga hiri ngawari. - ** Tikanga A - Huneumati (Air) Enema i raro i te Fluoroscopy:** Ko te hau hauora kua whakaritea ka kuhu marietia ki roto i te kopirua i te wa e maataki ana te kaitoro irirangi ki te fluoroscopy iti horopeta X-ray, kaua rawa e tuku kia neke ake te pehanga intracolonic ki te 80 ki te 120 mmHg. Ko te urunga o te hau ka pana whakamuri whakamuri i te whare whakamuri me te piki piki tae noa ki te hokinga mai i roto i te puera ileocecal ki roto i te ileum kapeka (whakapumautia ma te kite i te rere o te hau ki roto i te whekau iti). - ** Tikanga B - Hydrostatic (Saline Warm or Water-Soluble Contrast) Enema i raro i te Ultrasound:** Ko te tote maana mahana i whakairihia ki te teitei 3 putu (90 ki te 100 cm) kei runga ake o te teepu ka rere ata ki roto i te koroni i raro i te tirohanga o te ultrasound tonu (kore radiation) tae noa ki te matara katoa o te papatipu whainga ka puta noa atu te papatipu whainga ki roto i te waiu tote i roto i te whare tote. - Pehea mena ka nekehia te whekau i te nganatanga tuatahi? Mena kei te mau tonu te tamaiti kaore he peritonitis me te reema tuatahi ka whakaiti i te mate urutomo, ka tohutohuhia e nga aratohu kua whakaroa te nganatanga enema tuarua (e tatari ana mo te 30 meneti ki te 2 haora mo te pupuhi venous i roto i te pakitara whekau ka heke i mua i te whakamatau i te rua, tuatoru ranei o nga tamariki ki te whakaora).

3. I te wa e hiahiatia ana te whakahekenga (Laparoscopy or Laparotomy) (10% ki te 15% o nga keehi)¶

Mena ka whakakorehia te whakaiti i te enema radiologic, kaore ranei e taea te turaki i te whekau ki muri i roto i te hiko o te ileocecal valve, ka kawea e te taote tamaiti te tamaiti ki te ruma whakahaere: - Whakaiti A-ringa (Te Tikanga a Cope): Na roto i te werohanga iti o te tapawha matau o raro, te laparoscope ranei, ka marietia e te taote poka ("miraka") te pito tawhiti** o te intussusception whakamuri mai i waho (kaore rawa e kumea ki te whekau tata, ka haea te whekau pakarukaru). - Te Wehenga Whanaketanga: Mena ka kitea he gangrenous/necrotic te whekau karu, he kowhaowhao, he mea na te tohu arataki pathologic hanganga (penei i te Meckel's diverticulum, polyp ranei), ka tangohia e te taote te wahanga kua pakaru, ka hono ano i nga pito hauora.

Te rarangi arowhai aromatawai i te taha o te moenga mo nga maatua me nga kaiparapara: te arotake i te matewai, te hinu, me nga tohu o te puku.¶

I a koe e kawe ana i te kohungahunga, i te kohungahunga ranei e whakapaetia ana kua uru mai ki te tari whawhati tata o te hōhipera, me aro turuki nahanaha nga paramedic me nga maatua i te ahua o te rere toto o te tamaiti me te ahu whakamua o te puku me te kore e pehi i te kopu:

• Tirohia te Wa Whakakī Kapii me te Whakanui Kiri: Me pehi marie ki te pokapū o te koiwi uma o te tamaiti (sternum) me te rae mo te 5 hēkona ka tuku. Me hoki mai te tae i roto i raro i te 2 hēkona. Ko te whakakii i te capillary e roa ana 3 hekona te roa atu ranei, nga pito hauhautanga he kopa, he kiri koma/he hina ranei te kiri e tohu ana kei te tangi te whekau arai i te nui o te plasma ("te mokowhiti-tuatoru") ki roto i te pakitara intestinal me te kohao puku, ka puta wawe te hypovolemic ru.
• Tirohia te Rere o te Manawa me te Tauira Manawa: Ko te tere o te manawa okioki i runga ake i te 160 ki te 180 pao i ia meneti i roto i te kohungahunga (ahakoa i waenganui i nga tangi tangi i te wa e takoto marie ana te peepi) he tohu whakatupato nui mo te mate wai, te ischemia whekau, te whakawhanaketanga o te sepsis.
• Tirotirohia te Tae Weki i runga i te Kakahu Ma: Hopukia, tirotirohia ranei te ruaki i runga i te tauera ma, i te pepa ranei.
• Te miraka/kai miraka ma, maamaa, kowhai kowhai ranei: Ko te ruaki whakamuri moata moata ka puta mai i te totoro o te nerve i te wa e kumea ana te mesentery ki roto i te kohungahunga.
• Ko te kotakota-matomato, te wai parakihi-matomato pouri ranei (Te Ruaki Piha): Ka whakaatu i te aukati whekau miihini i raro i te ampulla o Vater; whakamohiotia te nēhi triage i te taenga mai.
• Tirohia te Diaper me te Tatau i nga Repera Makuku i roto i nga haora 12 kua pahure ake nei: Tango katoatia te kope i te wa o te whakamatautau, hei tirotiro i te kumete mo te toto makutu, te hūpē "currant jelly" whero pouri ranei, me te tirotiro i nga riu hiku me te scrotum/labia ki te manatoko karekau te tamaiti i te whakawhao i te whekau.
• Tirohia te Waitohu Kanikani me te Kikitanga o te Tapa o Runga Matau: Ka whakangawari te peepi i waenga i te hamama, ka paopao ata te taote i te puku ka rongo he pukoro, he ngawari, he kopiko ** "he ahua hotiti" kei te taha matau o runga, kei waenganui ranei o te epigastrium** (kei te noho ana te haupae telescoped i roto i te whaa o raro), he hollow i roto i te kowha o raro. (Te tohu a te kanikani) na te mea kua toia atu te rewharewha me te hioocecal ki runga ake i to ratau tuunga.

Nga nama ohorere a rohe me nga tikanga umanga¶

Ko te whakapae i roto i te mahungatanga he pokanga tamariki me te ohotata irirangi i te wa tino nui:

• Te Hononga o Amerika me Kanata: Waea 911, haere tonu ranei ki te **Tari Ohotata Pediatric / Hospital mo nga Tamariki e tata ana ** (i te mea ko nga pokapū tiaki ohorere a te hapori me te maha o nga ER e tu ana ki te hunga pakeke-anake karekau he kairorohiko tamariki i runga i te waahi ki te mahi i te whakaheke i te hau/saline enema). Whakahaerehia i raro i American Academy of Pediatrics (AAP) me American Pediatric Surgical Association (APSA) nga aratohu haumanu.
• United Kingdom: Waea 999, haere tika ranei ki te hohipera Paediatric Emergency Department (A&E). I raro i nga tikanga NICE Acute Acute Abdominal Pain and Royal College of Surgeons / BSPED, ko nga kohungahunga e ruaki ana te ruaki, e whakapaetia ana ranei ka pangia e te mahunga o te kopu, ka tukuna tonutia ki te whakamatautauranga o nga tamariki me te whakamatautau irirangi.
• Uniana Pakeha: Waea 112. Ka whakahaerehia i raro i te European Society of Pediatric Radiology (ESPR) me nga aratohu a te European Pediatric Surgeons' Association (EUPSA).
• Ahitereiria me Aotearoa: Waea 000 i Ahitereiria, 111 ranei i Aotearoa. Whakahaerehia i raro i Royal Children's Hospital (RCH) Melbourne Clinical Practice Guidelines for Intussusception.
• India me Ahia-Kiwa: Waea 112 (ranei 108 i Inia), 995 i Singapore, 119 i Hapani me Korea ki te Tonga, 999 ranei i Malaysia me Hong Kong. Haere ki te hohipera tuatoru me te ultrasound pediatric 24-haora me te pokanga tamariki.

Pātai auau¶

He aha te pepi whai mate urutomo ka tangi ia 15 ki te 20 meneti ka noho ata noho, ka moe ranei i waenganui?¶

Ko te whekau iti o te tangata ka paheke i roto i nga ngaru (peristalsis) ia 15 ki te 20 meneti hei neke whakamua i te kai. I roto i te intussusception, i nga wa katoa ka pa te ngaru peristaltic ki te wahanga telescoped o te whekau, ka werohia e ia te whekau e mau ana, ka kumea ki runga i te kopu o te nerve, ka puta te 2 ki te 5 meneti o te mamae nui o te kopu i reira ka aue te peepi ka kumea nga turi e rua ki tona uma. Ka pahemo te ngaru whakaheke, ka mutu te mamae mo te wa poto, ka koma te kohungahunga, ka werawera, ka ngenge, ka tino ngenge ranei kia tae mai te ngaru peristaltic e whai ake nei 15 meneti i muri mai.

He aha te ahua o te peepi he mate pukupuku, he mate roro ranei?¶

Tae atu ki te 10 ki te 20 paiheneti o nga keehi, ka tukuna e te pakitara whekau kua matekai-hauora, kua kopakihia te nui o nga peptides (endorphins) me nga cytokine mumura ki roto i te toto o te peepi. Ko enei opioids taiao e mahi ana ki te roro o te kohungahunga ka nui te ngenge, te ngohe o te uaua (floppiness), te titiro kore, me nga akonga iti, i etahi wa i mua i te tuku toto o te peepi ki roto i tana kuemu, ka kitea ranei te mamae o te puku. Ka karangahia e nga taote tenei ko te "encephalopathic or lethargic intussusception," a na te tere o te ultrasound abdominal i te taha o te moenga ka kitea tonu te aukati i te whekau.

He aha te ahua o te "tuu tiēre currant" a kei nga peepi katoa e pangia ana?¶

He rite te ahua o te kumete tiēre o te fuamelie ki te tami gelatinous whero pouri ranei i konatunatua ki te kape. Ka puta mai i te wa e pupuhi ana nga uaua i roto i te whekau karu karu ana ka memeha haere te ararewa mucosal ka whakaheke toto ki roto i te pupuhi matotoru o te hūpē mai i ngā pūtau kopa intestinal. Heoi ano, iti iho i te 25 ki te 50 paiheneti o nga pepi ka kitea te kuetete tiēre currant i to ratou taenga tuatahi ki te rūma ohorere na te mea he tohu tomuri o te mucosal ischemia; kaua rawa e tatari ki te kite i te toto i roto i te kope i mua i te haere ki te hohipera.

Me pehea e taea ai e te reima hau, te tote ranei te whakatika i te whekau karu karekau he pokanga?¶

I te wa e whakahekehia ana te enema i te ultrasound-, i te X-ray-arataki ranei, ka tukuna e te tohunga irirangi tamariki he ngongo ngongo ki roto i te toka o te tamaiti me te whakauru marie i te hau hauora (pneumatic enema) me te wai tote mahana (hydrostatic enema) ki roto i te whekau nui. Ko te pou ngawari o te hau, o te wai ranei e pana ana ki te pito o te whekau iti kua whakamarumaruhia ano he piston, ka whakamuri i te karu i roto i te kopirua tae noa ki te hokinga mai ki tona turanga. Ko tenei mahi kore-hapara ka angitu i roto i te 85 ki te 90 paiheneti o nga tamariki ka mahia moata.

Ka taea e te werohanga rotavirus, te huaketo makariri ranei, ka pa mai te mate urutomo?¶

Ko te nuinga o nga keehi o te kohungahunga kohungahunga ka puta mai i te mate rewharewha o runga (pēnei i te adenovirus) te wheori puku ranei e pupuhi ana nga ngongo rewharewha noa i roto i te pakitara o te whekau iti (Peyer's patches) ka mahi hei "tohu arataki" tinana ka kumea ki roto i te kopirua. He iti rawa te mate o te kano kano rotavirus-waha (tata ki te 1 ki te 5 atu nga keehi mo ia 100,000 kohungahunga kua werohia, ko te nuinga i roto i nga ra tuatahi e 7 i muri i te horopeta tuatahi, tuarua ranei), i te wa ano ka aukati i nga mano tini o nga whakamohiotanga mate-mate rotavirus; Ka tohutohu noa nga matua ki te maataki mo nga turi-ki-uma e tangi ana i te wiki i muri mai o te werohanga.

Ka taea ano te intussusception i muri i te whakatikatika?¶

Ae. Ka hoki mai ano te Intussusception i roto i te 8 ki te 12 paiheneti o nga tamariki i muri i te pai o te whakahekenga o te hau me te tote i te enema, me te haurua o aua hohoutanga ka puta i roto i te 24 ki te 72 haora tuatahi i te wa e mimiti tonu ana te kiko lymphoid i te pakitara whekau. Mena ka tangi te tangi, te turi ki te uma, te ruaki, ka hoki mai ano te ngenge, hoki tonu ki te tari whawhati tata, ka taea ano te whakaheke i nga keehi me tetahi atu enema, ahakoa he maha nga hokinga ka akiakihia he arotake mo te tohu arataki penei i te Diverticulum a Meckel.

Nga puna me nga aratohu whai mana¶

• American Academy of Pediatrics (AAP) & American Pediatric Surgical Association (APSA, United States): Aratohu Mahinga Haumanu me nga Putanga Hapara mo te Pediatric Ileocolic Intussusception.
• Royal Children's Hospital (RCH) Melbourne (Ahitereiria): Te Aratohu Mahi Hauora: Te Intussusception, Te Aromatawai Ohotata, te Tohu Tohu Irarangi, me te Whakaiti i te Enema Pneumatic.
• World Health Organization (WHO): Acute Intussusception in Infants and Tamariki: Incidence, Clinical Presentation and Management, A Global Perspective.
• National Institute for Health and Care Excellence (NICE) & Royal College of Paediatrics and Child Health (RCPCH, United Kingdom): Ahukahuka me te Triage o Acute Pediatric Intestinal Obstruction and Bilious Vomiting.
• European Society of Pediatric Radiology (ESPR): He Aratohu mo te Iratuki Taataitanga me te Whakaiti-Arahi Atahanga o te Intussusception i roto i nga Tamariki.

Nga kaiarahi e pa ana¶

• Te aukati i te whēkau, te strangulated hernia, me nga tohu ohorere volvulus
• Henoch-Schonlein purpura (IgA vasculitis), palpable purpura, and intussusception triage
• Pyloric stenosis, te ruaki kore-bilious projectile, me te alkalosis metabolic
• Appendicitis, te apiti pakaru, te peritonitis, me te mamae o te taha taha matau o raro
• Ko te paihana kai, ko te gastroenteritis whakapeka, me te matewai