Pyloric Stenosis: Kusanza Kopanda Bilious kwa Projectile mu Makanda Azaka 3 mpaka 8, Olive Mass, ndi Hypochloremic Metabolic Alkalosis¶

Infantile Hypertrophic Pyloric Stenosis (IHPS) ndi vuto lachipatala la ana komanso opaleshoni yadzidzidzi yomwe mphete yozungulira yosalala ya minofu ya **pylorus , valve yotuluka yomwe imagwirizanitsa pansi pamimba ndi gawo loyamba la matumbo aang'ono (duodenum), imakula mofulumira ndikutalika mkati mwa masabata a 2 otuluka m'mimba * 2. Chifukwa mkaka wa m'mawere kapena mkaka sungathenso kutuluka m'mimba kulowa m'matumbo, pamene ndulu yochokera ku ndulu imalowa * pansi pa valavu yotsekedwa, khanda limakhala lachidule ** lamphamvu, lopanda ma biliary (loyera, lokhala ndi mkaka, losabiriwira) kusanza ** nthawi yomweyo pambuyo pa kudyetsa, kumakhalabe koopsa ndipo amayesa kudyetsanso nthawi yomweyo chizindikiro () mafunde a m'mimba kuchokera kumanzere kupita kumanja kumtunda kwa mimba, ndipo ali ndi minofu yolimba, yosunthika "yoboola ngati azitona" kumtunda kwa mimba. Ngati mwana wochepera miyezi itatu akusanza mwamphamvu pambuyo poyamwitsa, kulowa mkati mwa fontanelle (malo ofewa), matewera owuma, kulefuka, kapena masanzi aliwonse obiriwira, imbani foni kwanuko. manambala angozi kapena pitani kuchipatala chapafupi chachipatala cha ana mwamsanga. Pokonzekera zoyendera, pendaninso malangizo ogwirizana nawo intussusception ndi matumbo a telescoping mwa makanda, kutsekeka kwa matumbo ndi midgut volvulus,ndi chakudya poyizoni, gastroenteritis, ndi kutaya madzi m'thupi.

Mfundo yofunika kwambiri yopulumutsira moyo wa chisamaliro chamwadzidzi kwa ana ndi yakuti pyloric stenosis ndi ngozi yotsitsimula zachipatala ASANAchite opaleshoni yadzidzidzi: chifukwa khanda lakhala likusanza hydrochloric acid m'mimba (HCl) kwa masiku, magazi awo amakula kwambiri hypochloremic, hypokalemic metabolic alkalosis ndi kutaya madzi m'thupi. Kutenga mwana yemwe ali ndi metabolic alkalosis molunjika kuchipinda chopangira opaleshoni Ramstedt pyloromyotomy asanakonze magazi awo chloride, potaziyamu, bicarbonate, ndi kuchuluka kwamadzimadzi mtsempha. 0.9% NaCl (Normal Saline) + potassium chloride ingayambitse moyo ** post-anesthetic central apnea ** (kusiya kupuma pambuyo pa opaleshoni) chifukwa ubongo wa alkalotic wa khanda umaganiza kuti sufunikira kupuma.

Chitani izi tsopano¶

1. Pitani kuchipatala chapafupi cha Pediatric Emergency Department (kapena imbani foni nambala yanu yazadzidzi yapafupi ngati khanda latopa, floppy, kapena kusanza chobiriwira chobiriwira). Imbani 911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, 000 ku Australia, kapena fufuzani chikwatu chathu cha manambala angozi. Muuzeni namwinoyo momveka bwino kuti: "Mwana wazaka [X] wa masabata omwe amasanza pang'onopang'ono pambuyo pa chakudya, amakhala ndi njala atangosanza, komanso kuchepa kwa matewera, omwe amaganiziridwa kuti ndi pyloric stenosis."
2. Yang'anani mtundu wa masanzi pansalu yoyera nthawi yomweyo (White Milk vs. Green Bile ndi 5-alarm foloko mumsewu).
3. Mkaka/mkaka wopindika woyera, woonekera bwino, kapena wachikasu (Wopanda Bilious): Wachikale wa pyloric stenosis (kutsekeka kuli pamwamba pa kutsegula kwa ndulu).
4. madzimadzi obiriwira obiriwira kapena obiriwira a sipinachi (Kusanza kwa Bilious): Awa ndi OSATI pyloric stenosis, ndi Malrotation with Midgut Volvulus (m'matumbo opindika otsekereza magazi ake pansi pa ndulu) mpaka atatsimikiziridwa kuti ayi, zomwe zimatha kupha matumbo aang'ono onse mkati mwa maola angapo ndipo zimafunikira mayendedwe achangu.
5. Siyani kudyetsa m'kamwa (popanda mkaka wa m'mawere, mkaka, madzi, kapena Pedialyte) mutangopita kuchipatala. Kupitiriza kuyamwitsa khanda lotuluka m'mimba kumangoyambitsa kusanza, kumatulutsa hydrochloric acid yambiri (HCl) ndi kloridi kutuluka m’magazi a mwanayo, ndipo kungachititse kuti m’mapapo mukhale mpweya wotuluka m’mapapo.
6. OSATI kupatsa mwana wakhanda madzi opanda madzi, madzi osakaniza, tiyi azitsamba, kapena mankhwala oletsa nseru. Kupatsa mwana wakhanda madzi osamwa madzi opanda kanthu kumayambitsa imfa hyponatremic kutupa muubongo (kukomoka), ndi anti-emetics (ondansetron, promethazine, metoclopramide) sikungatsegule minyewa yowopsa. akhanda.
7. Ŵerengani kuchuluka kwa matewera amvula m’maola 24 apitawa ndi kuwona malo ofewa a mwana (anterior fontanelle) ndi mtundu wa khungu. Onani pamene khandalo linakodza komaliza, kaya malo ofewa pamwamba pa mutu akumva kuti wamira, kaya mwanayo akulira popanda misozi, ndiponso ngati zoyera za m’maso kapena pakhungu zimawoneka zachikasu pang’ono (*icteropyloric syndrome of 2bi topy, icteropyloric syndrome) kukwera kwa bilirubin kosalunjika chifukwa cha njala).
8. Bweretsani zolemba za maantibayotiki aliwonse operekedwa kwa khanda kapena mayi (makamaka Erythromycin kapena Azithromycin). Oral macrolide antibiotics (erythromycin ndi azithromycin) amakhala ngati amphamvu a motilin-receptor agonists omwe amayambitsa kugunda mwamphamvu kwa m'mimba; kuwonetseredwa pa **masabata awiri oyambirira a moyo ** kumawonjezera chiopsezo cha pyloric stenosis ** 8-fold to 10-fold **.

Mtengo wosankha: kuyesa kusanza kwa makanda (Bilious Volvulus vs. Pyloric Stenosis vs. Reflux)¶

flowchart TD
    Start["Kusanza kwa Mwana Wakhanda (Kubadwa Mpaka Masabata 12 Akubadwa)"] --> ColorCheck{"1: Kodi masanzi a pansalu yoyera ndi amtundu wanji?"}

    ColorCheck -->|"WOGIRIRA WOYERA KAPENA WOWIRIRA WOGWIRIRA (Kusanza Kwambiri)"| Volvulus["5-ALARM OR ORIGICAL EMERGENCY: Kukayikiridwa Malrotation ndi Midgut Volvulus. Imbani 911 / 112 / 999 Nthawi yomweyo, Strictly NPO, Emergency Upper GI Contrast Study & Immediate Ladd Procedure"]

    ColorCheck -->|"WOYERA / WOWIRITSIDWA MAKA KAPENA WOYERA (Kusanza Kopanda Bilious)"| PatternCheck{"Khwerero 2: Kodi kusanza kumakhala kokakamiza mwana akamadyetsa mwana wazaka ziwiri mpaka zisanu ndi zitatu amene akufuna kudyetsanso ('Njala Vomiter'), mochepa thupi kapena matewera ochepa?"}

    PatternCheck -->|"INDE: AMAGANIZIWA PYLORIC STENOSIS"| Pyloric["Kuyesa Kwadzidzidzi kwa Dipatimenti Yadzidzidzi ya Ana: Molimba NPO, Yang'anani Gasi wa Magazi & Electrolytes (Cl, K, HCO3), Pangani Pyloric Ultrasound ('3-14-4 Rule'> 3 mm thick,> 15 mm kutalika)"]

    PatternCheck -->|"NO: Onani Systemic Sepsis / Adrenal / Metabolic Signs"| SickCheck{"Kodi khanda la khanda limakhala lotopetsa, lotentha kapena lotentha kwambiri, latachypneic, kapena likuwonetsa potaziyamu wambiri + low sodium (Congenital Adrenal Hyperplasia salt-wasting crisis)?"}

    SickCheck -->|"INDE"| SepsisCAH["Kutsitsimutsidwa Kwachipatala Kwachangu: Chotsani Neonatal Sepsis, Meningitis, Urea Cycle Disorder, kapena Congenital Adrenal Hyperplasia (CAH)"]

    SickCheck -->|"AYI: Kuthamanga kwa 'mavuvu osangalala' mosavutikira, kunenepa kosasunthika, matewera onyowa 6+/tsiku"| GER["Reflux ya Gastroesophageal Reflux (GER) Yosavuta: Kuyika mowongoka mphindi 20-30 mutatha kudyetsa, kudyetsa pang'ono pafupipafupi, kutsatira kwa ana pafupipafupi."]

    Pyloric --> Resus["Khwerero 3: KUBWERA KWA MEDICAL POYAMBA (Maola 12-24+): IV 0.9% Normal Saline Bolus + D5 0.9% NaCl ndi KCl mpaka Chloride >= 100 mEq/L ndi Bicarbonate <28-30 mEq/L, THENaparoscopic Ramstedtyoroscopic Ramstedtyo"]

Pathophysiology: anatomy ya hypertrophied pylorus ndi chifukwa chake ma electrolyte amawonongeka¶

1. Chifukwa chiyani mphete ya minofu ya pyloric imakhuthala pazaka zitatu mpaka 6 zakubadwa¶

Pakubadwa, pyloric sphincter ya khanda imakhala yachibadwa. Pazaka zoyambirira 2 mpaka masabata 8 amoyo (chiwonetsero chapakati pa milungu 5 yakubadwa; zimakhudza 2 mpaka 4 pa ana 1,000 obadwa, ndi **4:1 chiŵerengero cha mwamuna ndi mkazi *, makamaka mwa anyamata oyamba kubadwa), minyewa yozungulira yosalala ya pylorus imakhala yolembedwa hypertrophy (hypertrophy) ndi hypertrophy (kuchulukitsitsa) (cell enlargement) - Kuperewera kwa Neuronal Nitric Oxide Synthase (nNOS): Mkati mwa minofu ya pyloric, mitsempha ya enteric imatulutsa nitric oxide (NO) kuti mupumule sphincter kuti mkaka upite mu duodenum. Makanda omwe ali ndi pyloric stenosis amakhala ndi vuto la m'deralo la neuronal nitric oxide synthase ndi maselo apakati a Cajal; sphincter imalephera kumasuka, ndipo mimba imagwirizanitsa mwamphamvu khomo lotsekedwa, zomwe zimapangitsa kuti mphete ya minofu ya pyloric ikhale yochuluka ngati bicep ya weightlifter mpaka ipange gristly, misa ya azitona yomwe imatsina lumen kutseka. - Zowopsa Zazikulu: 1. Kugonana kwa amuna & kukhala woyamba kubadwa (anyamata amakhudzidwa 4 mpaka 5 nthawi zambiri kuposa atsikana; pafupifupi 30% ndi amuna oyamba kubadwa). 2. Mbiri yabanja (ngati mayi anali ndi pyloric stenosis ali khanda, mwana wake wamwamuna amakhala ndi chiopsezo cha 20% ndipo mwana wake wamkazi amakhala pachiwopsezo cha 7%. 3. ** Kuwonekera kwa maantibayotiki a Macrolide (Erythromycin kapena Azithromycin): Amaperekedwa mwachindunji kwa wakhanda m'masiku 14 oyambirira a moyo (mwachitsanzo, pertussis prophylaxis kapena Chlamydia conjunctivitis) kapena kudzera mu mkaka wa m'mawere. 4. **Kudyetsa botolo ndi kusuta kwa amayi ** pa nthawi ya mimba.

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: Momwe kusanza kumayambitsa Hypochloremic, Hypokalemic Metabolic Alkalosis ndi "Paradoxical Aciduria"¶

Kumvetsetsa vuto la electrolyte la pyloric stenosis nkofunika chifukwa kukonza chloride ndi kuchepa kwa voliyumu ndiko kumapulumutsa moyo wa khanda:

1. Khwerero 1 - Kutaya Kwakukulu kwa Hydrochloric Acid (HClKuchokera m'mimba (Hypochloremic Alkalosis):
2. Chifukwa kutsekekako kuli *pamwamba pa duodenum (pamene alkaline pancreatic bicarbonate imalowa), masanzi a khanda amakhala ndi madzi am'mimba omwe ali ndi haidrojeni.H+Chloride ()Cl-sodium, sodium (Na+ndi potaziyamu pang'ono (K+).
3. Kwa aliyense H+ Ma cell am'mimba a parietal amapopa ndikutaya masanzi, amataya Bicarbonate imodzi (HCO3-) ion m'magazi a mwana ("mafunde amchere"). Nthawi zambiri, asidiyo amafika m'matumbo a duodenum ndikuyambitsa kutulutsidwa kwa pancreatic bicarbonate kuti magazi aziyenda bwino; mu pyloric stenosis, asidi amasanziridwa pansi, kusiya magazi okwera kumwamba Bicarbonate (HCO3- > 30 mpaka 40 mEq/L) ndi magazi otsika kwambiri Chloride (Cl- <85 mpaka 95 mEq/L).
4. Khwerero 2 - Kutaya madzi m'thupi Kumayambitsa Renin-Angiotensin-Aldosterone Surge (Hypokalemia):
5. Mwana akamataya madzi m'thupi komanso hypovolemic, impso zimamva kutsika kwambiri kwa magazi ndikutulutsa Aldosterone yambiri.
6. Aldosterone imalamula ma tubules a distal aimpso kuti ** atengerenso molekyulu iliyonse ya Sodium (Na+)** kusunga kuthamanga kwa magazi, koma kukoka mwamphamvu Na+ Kubwerera m'magazi, impso iyenera kutulutsa potaziyamu yomwe ili ndi mpweya wabwino.K+*** kulowa mkodzo, kupangitsa kuti potaziyamu mu seramu ikhale yotsika kwambiri (Hypokalemia), K+ < 3.5 mEq/L).
7. Khwerero 3 - "Paradoxical Aciduria" (Chifukwa Chake Mwana Wamchere Amatulutsa Mkodzo Wa Acid):
8. Poyambirira, impso zimayesa kukonza magazi amchere mwa kutaya bicarbonate mumkodzo (kupanga mkodzo kukhala alkaline).
9. Kamodzi Chloride (Cl-* ndiPotaziyamu (K+)* imachepa kwambiri, impso ilibe ma anion a chloride omwe amasiyidwa kuti alowenso pamodzi ndi sodium, ndipo palibe potaziyamu wotsalira kuti agulitse sodium mu distal tubule. Pofunitsitsa kupulumutsa sodium ndi madzi kuti mtima wa mwanayo ukhale ukugunda, mapampu a impso a aldosterone amakakamizika kuti kutulutsa Hydrogen (H+ asidi) ma ions mumkodzo posinthanitsa ndi sodium (Na+).
10. Izi zimatchedwa Paradoxical Aciduria: magazi a mwanayo ndi owopsa alkaline (pH > 7.50), komabe mkodzo wa mwanayo uli acidic (urine pH < 5.5), kupangitsa kuti alkalosis amagazi achuluke kwambiri ola lililonse mpaka mtsempha wamkati Chloride (0.9% NaClndi potaziyamu (KCl) amapatsidwa.

Kuzindikira Pyloric Stenosis vs. Midgut Volvulus, Gastroesophageal Reflux (GER), ndi Adrenal Crisis¶

Gome lofanizira lachipatala ndi zamankhwala: kusiyanitsa khanda losanza¶

Momwe asing'anga amawonera "Peristaltic Wave" ndikumva "Misa ya Azitona"¶

1. Kuwona Mafunde a Peristaltic Wave: Vumbulutsani mimba ya khanda m'chipinda chofunda kwinaku mukumuviika m'madzi a shuga (kapena kuyang'ana asanasanze). Mutha kuwona kakulidwe kakang'ono kakang'ono ka mpira wa gofu pansi pa nthiti zakumanzere, kugwedezeka pang'onopang'ono kumtunda kuchokera ku **kumanzere kupita kumanja **, ndikuchoka pakati pomwe minofu ya m'mimba ikuvutikira kukankhira pylorus yotsekedwa.
2. Palpating the Epigastric "Olive": Pamene m'mimba mulibe kanthu (kapena decompressed) ndipo minofu ya m'mimba ya mwana yamasuka (pokupiza chiuno cha mwanayo ndi kuwasiya kuyamwa pacifier), kugwedeza pang'onopang'ono pansi pa chiwindi chapakati kumanja kwa mzere wapakati kumawonetsa kulimba, 1. ** azitona wokhazikika ** (** 70% mpaka 90% mtengo wolosera wabwino ** akamvedwa ndi woyesa wodziwa zambiri).

Kuzindikira kuchipatala: Ultrasound "3-14-4 (kapena 3-15-4) Rule"¶

Masiku ano, madokotala sakufunikanso kukakamiza mwana aliyense kumwa barium pa X-ray pokhapokha ngati ultrasound ikulephera. Kuthamanga kofulumira, kosapweteka, kopanda ma radiation Pyloric Ultrasound ili ndi 98% mpaka 100% kumva komanso kutsimikizika:

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"

Chithandizo chotsimikizika chachipatala cha magawo awiri: IV Electrolyte Correction POYAMBA, Kenako Ramstedt Pyloromyotomy¶

Gawo 1: Kutsitsimula Kwachipatala Kusanachitike (Maola 12 mpaka 48)¶

Mwana asanachotsedwepo kuti amugonjetse, gulu ladzidzidzi la ana ndi magulu ochita opaleshoni amaika ndondomeko yokhazikika yamadzimadzi ndi electrolyte restoration protocol:

1. Sing'anga NPO: Imitsani ma feed onse apakamwa. (Kuyamwa kwa nasogastric chubu kupewedwa pokhapokha ngati mwanayo akupitiriza kusanza pamene NPO, chifukwa kuyamwa kwa NG kosalekeza kumayamwa kwambiri hydrochloric acid ndi chloride kuchokera m'mimba ndikutalikitsa kagayidwe kachakudya.).
2. Kutsitsimula Koyamba Kwa Voliyumu (Ngati Kumwa Madzi): Yang'anirani 10 mpaka 20 mL/kg ma boluses a isotonic 0.9% Sodium Chloride (Normal Saline) mpaka kugunda kwa mtima, kudzaza kapilari, ndi kutuluka kwa mkodzo kukhale kokhazikika. Musagwiritse ntchito Lactated Ringer's kapena Plasmalyte, chifukwa lactate ndi acetate zimasinthidwa ndi chiwindi kukhala zambiri* bicarbonate, zomwe zimakulitsa kagayidwe kachakudya.
3. Kukonza + Kulowetsa Chloride & Kulowetsedwa kwa Potaziyamu: Thamangani manthawi 1.5 amadzimadzi okonza IV pogwiritsa ntchito 5% Dextrose in 0.9% NaCl (kapena 0.45% NaCl ngati yofatsa), ndi mwana wakhanda akangokodza (kutsimikizira kugwira ntchito kwa impso), onjezerani 20 to 30 mEq/L of Potassium Chloride (KCl).
4. Zolinga za Pre-Anesthesia Laboratory Clearance: Bwerezani mapanelo oyambira a metabolic maola 6 mpaka 12 aliwonse. Mwana wakhanda amaloledwa kulowa m'chipinda chopangira opaleshoni POKHA pamene zolinga zonse zinayi zakwaniritsidwa:
5. ** Serum Bicarbonate (HCO3-) / Total CO2:** <28 mpaka 30 mEq/L (moyenera < 26 to 28 mEq/L)
6. ** Seramu Chloride (Cl-):** >= 100 mEq/L
7. ** Potaziyamu ya Serum (K+):** 3.5 mpaka 5.0 mEq/L (yabwinobwino)
8. ** Seramu sodium (Na+):** >= 132 mpaka 135 mEq/L ndi Kutulutsa kwa Mkodzo Wamphamvu (> 1 to 2 mL/kg/hr).

Gawo 2: Kuwongolera Opaleshoni (Laparoscopic Ramstedt Pyloromyotomy)¶

Kapangidwe ka magazi kakakhala koyenera, dokotala wa ana amapanga Ramstedt Extramucosal Pyloromyotomy (kawirikawiri kudzera m'mabowo ang'onoang'ono atatu a 3-millimeter keyhole laparoscopic incision kapena cosmetic umbilical crease incision) mu 20 mpaka 30 mphindi: - Mmene Njira ya Ramstedt Imagwirira Ntchito: Dokotala wa opaleshoni amapanga motalikirapo motalikira kunja kwa mphete yolimba ya hypertrophied pyloric minofu ndikugwiritsa ntchito chowululira kuti kugawa ulusi wokhuthala kwambiri mpaka ku submucosal wosanjikiza POPANDA kudula tsegulani chubu chofewa chamkati cha mucosal. - Mphuno yamkati yomwe ili mkati mwake imalowa mumtsempha, ndikutsegula njira yotakata yochokera m'mimba kupita ku duodenum. - Kuyamwitsa Pambuyo Pogwira Ntchito & Kuchira: Kudyetsa pakamwa (mkaka wa m'mawere kapena mkaka) kumayambikanso **maola 4 mpaka 6 pambuyo pa opaleshoni **. Dziwani kuti **kulavulira pang'ono kapena 1 mpaka 2 masanzi ang'onoang'ono m'maola 24 oyambirira mutatha opaleshoni ndi yachilendo ** (kuchokera ku edema ya opaleshoni ya pylorus ndi kutambasula kwamimba kosalekeza) ndikuthetsa mwamsanga; opitirira 95% a makanda amapita kwawo atachiritsidwa kwathunthu mkati mwa **24 kwa maola 36 ** atachitidwa opaleshoni, kutsatiridwa ndi pulse oximetry apnea monitoring nthawi zonse kuchipatala.

Mndandanda wapang'onopang'ono kunyumba ndi ambulansi kuopsa kwa kuchepa kwa madzi m'thupi kwa ana aang'ono¶

Chifukwa khanda la masabata anayi amalemera 3.5 mpaka 4.5 kilograms (7.7 mpaka 10 pounds) ndipo ali ndi magazi ochepa ozungulira pafupifupi 280 mpaka 360 milliliters, kutaya mamililita 30 mpaka 50 okha amadzimadzi kuchokera ku kusanza kwa moyo. hypovolemic shock mkati mwa maola 24. Gwiritsani ntchito tebulo lachipatalali kuti muone kuchuluka kwa kuchepa kwa madzi m'thupi la mwana wanu pokonzekera zoyendera zadzidzidzi:

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

Mwana wakhanda aliyense wosakwana miyezi itatu yemwe ali ndi kusanza mwamphamvu, kulefuka, kapena kusanza koopsa amafunikira kuwunika mwadzidzidzi kuchipatala:

• United States ndi Canada: Imbani 911 (ngati mukusanza, kulefuka, kapena kunjenjemera) kapena pitani kuchipata chapafupi cha Chipatala cha Ana/Dipatimenti Yowopsa ya Ana. Imayendetsedwa pansi pa American Pediatric Surgical Association (APSA) ndi American Academy of Pediatrics (AAP) njira zamankhwala.
• United Kingdom: Imbani 999 kapena pitani mwachindunji kuchipatala Paediatric Emergency Department (A&E). Pansi pa NICE Postnatal Care and Pediatric Vomiting / BSPED Guidelines, kusanza kwa khanda lazaka ziwiri mpaka 8 kumalamula kuti atumizidwe kuchipatala tsiku lomwelo kuti afufuze mpweya wamagazi / electrolyte ndi ultrasound.
• European Union: Imbani 112. Imayendetsedwa pansi pa **European Pediatric Surgeons' Association (EUPSA) ** malangizo.
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand. Imayendetsedwa pansi pa Royal Children's Hospital (RCH) Melbourne Clinical Practice Guidelines: Pyloric Stenosis.
• India ndi Asia-Pacific: Imbani 112 (kapena 108 ku India), 995 ku Singapore, 119 ku Japan ndi South Korea, kapena 999 ku Malaysia ndi Hong Kong. Pitani ku chipatala chapamwamba chokhala ndi ma ultrasound a ana komanso luso la opaleshoni ya ana.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi ndingadziwe bwanji kusiyana pakati pa reflux wamba ("kulavulira") ndi pyloric stenosis?¶

Reflux yachibadwa ya khanda (gastroesophageal reflux) siigwira ntchito: mkaka umatuluka pang'onopang'ono kuchokera pakona ya mkamwa mwa khanda pamene akumenyetsa kapena pambuyo pake, mwanayo amalemera pang'onopang'ono, ndipo matewera amadzimadzi amakhala abwino. Pyloric stenosis nthawi zambiri imayamba pakati pa masabata atatu ndi asanu ndi limodzi ndipo imakhala yamphamvu pang'onopang'ono tsiku lililonse mpaka mkaka wa m'mawere kapena mkaka umatuluka mkamwa modutsa pa bere (kusanza) atangoyamwitsa, komabe khanda limangolira ndi mizu ndi njala kuti lidyetsedwenso ("osanza anjala") kwinaku akuchepa thupi.

Nchifukwa chiyani masanzi obiriwira (bilious) mwa mwana wakhanda amakhala ofulumira kuposa pyloric stenosis?¶

Mu pyloric stenosis, kutsekeka kwa minofu kumakhala pamimba yotuluka * pamwamba pa ampulla ya Vater pomwe ndulu yobiriwira kuchokera pachiwindi imalowa m'matumbo, motero masanzi a pyloric stenosis amakhala oyera kapena amtundu wamkaka (osabiriwira). Mwana akasanza zobiriwira zobiriwira kapena zachikasu zobiriwira, kutsekeka kwake kumakhala * kunsi kwa * ndulu, komwe kumakhala kowopsa kwambiri chifukwa cha kuwonongeka kwa midgut volvulus, pomwe matumbo ang'onoang'ono onse amapindika mozungulira mtsempha wake waukulu (mtsempha wapamwamba kwambiri wa mesenteric). Midgut volvulus imatha kuyambitsa matumbo onse ndi kufa mkati mwa maola angapo ndipo imafuna opaleshoni yadzidzidzi.

Chifukwa chiyani dokotalayo sangapange opaleshoni ya pyloric stenosis ya mwana wanga nthawi yomweyo asanamupatse madzi a IV kwa tsiku limodzi?¶

Masiku akusanza koyera m'mimba asidi (hydrochloric acid) amasiya mwana ali ndi magazi ochepa a chloride, potaziyamu yochepa, ndi bicarbonate yamagazi (hypochloremic metabolic alkalosis). Malo opumira muubongo wa mwana wakhanda amadalira milingo yabwinobwino ya asidi ndi carbon dioxide mumadzi amsana kuti ayambitse mpweya uliwonse. Ngati khanda ndi wosakonzedwa kagayidwe kagayidwe kachakudya alkalosis amaikidwa pansi mankhwala ochititsa ambiri pamaso mtsempha wachibadwa saline ndi potaziyamu kolorayidi kubwezeretsa yachibadwa magazi zimapangidwira, mwanayo amakumana ndi chiopsezo chachikulu cha imfa pambuyo opaleshoni apnea (kusiya kupuma pambuyo opaleshoni) ndi mtima arrhythmias.

Chifukwa chiyani ana ena omwe ali ndi pyloric stenosis amakhala ndi maso achikasu (jaundice)?¶

Pafupifupi 2 mpaka 5 peresenti ya makanda omwe ali ndi pyloric stenosis amakhala ndi chikasu chachikasu pakhungu ndi maso oyera, omwe amatchedwa "icteropyloric syndrome." Njala yowopsa ya caloric komanso kuchepa kwa madzi m'thupi kumapondereza enzyme ya chiwindi (UGT1A1, enzyme yomweyi yomwe imakhudzidwa ndi matenda a Gilbert) omwe amatulutsa bilirubin yosalunjika. Opaleshoni ikangotha ​​ndipo mwanayo ayambiranso kuyamwitsa mkaka wamba, jaundice imazimiririka yokha pakangopita masiku ochepa.

Kodi kutenga erythromycin kapena azithromycin kunayambitsa pyloric stenosis ya mwana wanga?¶

Oral macrolide maantibayotiki, makamaka erythromycin ndi azithromycin, amamanga molunjika ku zolandilira za motilin m'mimba mwa khanda, zomwe zimayambitsa kupindika kwamphamvu kwa minofu yosalala komwe kumapangitsa pyloric sphincter ku hypertrophy. Kafukufuku akuwonetsa kuti makanda omwe amapatsidwa erythromycin kapena azithromycin m'masiku 14 oyambirira a moyo amakhala ndi chiopsezo chowonjezeka cha 8 mpaka 10 chokhala ndi pyloric stenosis.

Kodi mwana wanga adzakhala ndi vuto la m'mimba kwa nthawi yayitali pambuyo pa Ramstedt pyloromyotomy?¶

Ayi. Ramstedt pyloromyotomy ya laparoscopic imachiritsa pyloric stenosis kwa ana oposa 99 peresenti, ndipo minofu yogawanika ya pyloric imafewetsa ndi kukonzanso kukula kwake mkati mwa masabata. Akachiritsidwa, ana omwe anali ndi pyloric stenosis amakhala ndi chimbudzi chokwanira, amakula bwino, ndipo alibe chiopsezo chowonjezeka cha zilonda zam'mimba kapena mavuto a m'mimba pambuyo pake.

Magwero ndi malangizo ovomerezeka¶

• **American Pediatric Surgical Association (APSA) & American Academy of Pediatrics (AAP, United States): ** *Malangizo Othandizira Othandizira Kuzindikira, Preoperative Fluid Resuscitation, ndi Laparoscopic Management of Infantile Hypertrophic Pyloric Stenosis *.
• Chipatala cha Royal Children's Hospital (RCH) Melbourne (Australia): Malangizo Othandizira Zachipatala: Pyloric Stenosis (Zolinga za Electrolyte, IV 0.9% Sodium Chloride Protocol, ndi Ultrasound Criteria).
• National Institute for Health and Care Excellence (NICE, United Kingdom): Postnatal Care & Gastro-Oesophageal Reflux Disease mu Ana ndi Achinyamata: Red Flags for Projectile and Bilious Vomiting (NG1).
• Centers for Disease Control and Prevention (CDC, United States): MMWR Guide on Macrolide Antibiotic Exposure (Erythromycin ndi Azithromycin) mu Early Infancy and Risk of Hypertrophic Pyloric Stenosis.
• Society for Pediatric Anesthesia (SPA): Malangizo pa Preoperative Bicarbonate and Chloride Normalization to Prevention Post-Apnea Apnea kwa Makanda Amene Ali ndi Pyloric Stenosis.

Maupangiri ogwirizana¶

• Intussusception (telescoping bowel) mwa makanda ndi makanda
• Kutsekeka kwa matumbo, chophukacho chokoka, ndi zizindikiro zadzidzidzi zadzidzidzi
• Chakudya poyizoni, pachimake gastroenteritis, ndi kutaya madzi m'thupi
• Matenda a Adrenal ndi jakisoni wadzidzidzi wa matenda a Addison
• CPR ya ana ndi makanda ndikutsamwitsidwa