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Usana oluneBhiliyoli (Luhlaza) Ukugabha, Ukugabha ngeProjekthi, kunye ne-Intussusception (Isitulo se'Currant Jelly')

Amanani kaxakeka ayohluka ngokwamazwe. Eli phepha lisebenzisa u-911, inani laseMelika naseKhanada. Amanye amazwe amaninzi asebenzisa i-112, 999, okanye elinye inani. Fumana inombolo yelizwe lakho.

Ngelixa ubisi oluthambileyo, olungenamsebenzi lutshica (gastroesophageal reflux) kwenzeka ngaphezu kweepesenti ze-70 zeentsana ezinempilo emva kokutyiswa, ** iipatheni ezintathu ezihlukeneyo zokugabha kosana kunye neentlungu zesisu ziyinyani yongxamiseko yokuhlinzwa yabantwana ** apho ukulibaziseka nokuba ** 2 ukuya kwiiyure ze-6 ** kunokubangela i-necrosis ye-intestinal necrosis, i-hypovolemic shock, okanye ukufa: ** (1) i-lime-green ebomvu ebangelwa yi-bilious e-spinach* okanye I-Intestinal Malrotation kunye ne-Midgut Volvulus, (2) Ukugabha okunamandla, okungenayo i-biliary "projectile" kusana oluneveki ezi-2 ukuya kwezi-8 olubangelwa Hypertrophic Pyloric Stenosis (HPS), kunye (3) Ngequbuliso, amaza ajikelezayo okukhwaza okungathuthuzelekiyo apho umntwana okwinyanga ezi-3 ukuya kwezingama-36 ubudala etsala amadolo esifubeni, ajike amnyama/abulaleke phakathi kwe-spasms, aze adlulise igazi-kunye ne-mucus ("currant jelly") isitulo esibangelwa yi *Ileocolic Intussusception.

Ukuba usana lwakho lugabha ulwelo olumnyama okanye oluluhlaza okuqaqambileyo nokuba kube kanye, luqhwalela, lungaphenduli, okanye lube ngwevu, libe sisisu esiqinileyo okanye esidumbileyo, okanye liyekile ukuvelisa idiapers ezimanzi, tsalela umnxeba kwinombolo yakho kaxakeka yasekuhlaleni.911 eUnited States naseKhanada, 112 kwiManyano yaseYurophu, 999 eUnited Kingdom) okanye ujonge uluhlu lwethu lwamazwe ngamazwe lwe amanani kaxakeka ngoko nangoko. Malunga neemeko ezingxamisekileyo zomkhuhlane, bona umkhuhlane weentsana ophezulu kunye nokuxhuzula kwe-febrile. Landela ezi nkqubo zovavanyo lotyando lwabantwana zingezantsi.

Yenza oku ngoku

  1. Nyanga NAYAYIPHI na i-lime-green eqaqambileyo okanye ihlathi elimnyama-luhlaza (bilious) ukugabha kusana njengemeko yotyando olusongela ubomi (Midgut Volvulus) de kungqinwe ngenye indlela: Ukutshica okuqhelekileyo kwesisu kumhlophe, kucacile, okanye kutyheli bhotolo (ukusuka kumthubi, amafutha obisi, okanye iasidi yesisu). I-bile eluhlaza ingena kwi-gastrointestinal tract kwi-*nxalenye yesibini ye-duodenum (Ampulla of Vater)**. Ukuba i-bile eluhlaza iphuma emlonyeni wosana, amathumbu avaliwe ngokwasemzimbeni ** ngaphantsi kwe-bile duct , kwaye amathumbu amancinci onke anokujijwa ngama-360 degrees malunga nokunikezelwa kwegazi.superior mesenteric artery volvulus), ujongene nokuqhambuka kwamathumbu ngaphakathi ** ezi-2 ukuya kwezi-6 iiyure.
  2. ** Thatha ifoto ecacileyo ye-smartphone yomhlanzo (kwishiti elimhlophe / ilaphu eliqhumayo) kunye ne-diaper, kwaye uzise i-diaper engcolileyo kwisikhwama se-Ziploc kwiSebe likaNgxamiseko **: Ngaphantsi kwezibane ezikhanyayo zesibhedlele ezikhanyayo, ebonisa ugqirha ongxamisekileyo ifoto ** ye-emerald / isipinatshi-eluhlaza okohlaza kwebilious ** okanye i-diaper equkethe i-"stool jelly" ebomvu ngeeyure * ezibomvu ze-mucoid ukulibaziseka kwaye kubangele uthethwano lotyando olukhawulezileyo.
  3. YIMA konke ukutya ngomlomo (NPO , akukho lubisi lwebele, ubisi olungumgubo, amanzi, okanye izisombululo ze-electrolyte) ngoko nangoko xa usiya kwiSebe likaxakeka: Ukuba usana lwakho lunezibilini ezijijekileyo (volvulus), izibilini zetelescopic (intussusception), okanye isisu esivaliweyo (pyloric stenosis), ukubeka ulwelo oluninzi esiswini kubangela ukuhlanza okuphindaphindiweyo, ukulangazelela kwimiphunga, kunye nokulibazisa i-anesthesia jikelele yokuhlinzwa okanye ukunciphisa i-enema yomoya.
  4. Gcina usana olugabhayo lubekwe ecaleni kwalo (Lateral Recovery Position) okanye ugcinwe nkqo phezu kwegxalaba lakho ngexesha lokuhamba: Ungaze ulalise usana olubuhlungu xa lugabha okanye emva kwe-spasm emqolo apho iasidi yesisu esiphindayo okanye inyongo inokuphefumlelwa kuqhoqhoqho.
  5. Yazi i-"Silent Lethargy Trap" ye-Intussusception: Phakathi kohlaselo olukhwazayo (olwenzeka rhoqo 15 ukuya kwimizuzu engama-20 njengoko amaza eperistaltic ecudisa amathumbu eteleskopu), usana olune-intussusception luhlala lukhupha ii-endorphins ze-endogenous kwaye lube *luzolile, luphumle, luphaphatheke, luphaphatheke, luphaphatheke. Ungaze wenze impazamo yokuba umsantsa wemizuzu eli-15 "umntwana uziva ngcono kwaye alale", luphawu loxinzelelo lwe-venous ye-mesenteric kunye nomothuko we-neurogenic.
  6. Yiya ngqo kwiSibhedlele saBantwana esizinikeleyo okanye iSebe likaNgxamiseko lwaBantwana elixhotyiswe nge-24/7 ye-Pediatric Ultrasound kunye noTyando lwaBantwana: Ukuxilongwa kunye nokulungisa i-pyloric stenosis, intussusception (pneumatic/hydrostatic enema reduction), kunye ne-midgut volvulus (Ladd procedure) ufuna iingcali zemitha yabantwana kunye noogqirha botyando; ukuya ngqo kwiziko labantwana ligcina i-2-hour inter-hospital transfer ambulensi.

Danger

Ikhowudi yoMbala egcina amathumbu oNtsana (Yellow vs. Green Vomit): - Mhlanzi oMhlophe okanye oMthubi weLamuni-oMthubi (Non-Bilious): Iqulethe i-milk curds, mucus, kunye ne-gastric fluid esuka ngasentla kwi-pyloric sphincter kunye nenyongo. Okuqhelekileyo kwi-reflux eqhelekileyo, i-viral gastroenteritis, kunye ne-Pyloric Stenosis. - Ikalika eqaqambileyo-eluhlaza, iHighlighter-Green, iSoup ye-Pea-Green, okanye iSipinatshi esiMnyama-iGabha eliluhlaza (Bilious): Inenyongo yesibindi esuka ngezantsi kweAmpulla yeVater. Ngokutsho kwe- ** American Pediatric Surgical Association (APSA)** kunye neKholeji yaseRoyal of Paediatrics kunye neMpilo yaBantwana (RCPCH), ukugabha okubuhlungu kusana olusandul’ ukuzalwa okanye lusana luDidi loku-1 lotyando olungxamisekileyo olufuna uvuselelo olungxamisekileyo lwesebe elingxamisekileyo kunye ne-Upper GI umahluko ongxamisekileyo we-fluoroscopy / i-ultrasound ukukhupha i-Midgut Volvulus. Ungaze ulinde ubusuku bonke ukuze ubone ukuba ukugabha okuluhlaza kuyayeka.

Umthi wesigqibo: ukugabha komntwana kunye nokuvavanywa kweentlungu zesisu ezibukhali

Sebenzisa le tshati yekliniki ukwahlula ukutshica komntwana kwiimeko ezintathu ezingxamisekileyo zotyando lwabantwana:

flowchart TD
    Start["Usana okanye uMntwana oNcinci onokugabha okunyanzelisayo, uMhlanzi oLuhlaza, okanye uKhala iiSpasms zesisu"] --> ColorCheck{"1. NguMbala Onjani Wokugabha?"}
    ColorCheck -->|"OKLIMILEYO-EHLALA-LUHLAZA OKANYE EMNYAMA ISIPINACH-ELUHLAZA (I-Bilious)<br/>(Nokuba isiqendu esinye kuMntwana)"| Volvulus["UDIDI LWE-1 IXESHA LIKAXAKEKA: UMrhanelwa MIDGUT VOLVULUS<br/>1. Misa konke ukutya (NPO) -> Gcina usana ecaleni<br/>2. Foto igabha eliluhlaza -> Yiya ku-Peediatric ED NGOKUNGOKO<br/>3. Ifuna i-IV resuscitation + Ingxamisekile ye-GI ephezulu / i-Ultrasound kunye neNkqubo yoCando lweLadd"]
    ColorCheck -->|"OMHLOPHE / UBISI OLUGQIBILEYO / LUCACAYO / OMTHULU OLULULU (AlunaBili)"| PatternCheck{"2. Yintoni iPhatheni yeKlinikhi kunye nobudala bomntwana?"}
    PatternCheck -->|"Ubudala obu-2 ukuya kwiiVeki ezisi-8:<br/>Ukugabha 'Okunyanzelekileyo' okuNyanzelelayo ukudutyulwa ngapha kwe-crib emva kokutyisa"| Pyloric["CELA I-HYPERTROPHIC PYLORIC STENOSIS (HPS)<br/>1. Misa ukutya -> Yiya kwi-ED yabantwana namhlanje<br/>2. Jonga ukuphelelwa ngamanzi emzimbeni + Hypochloremic Hypokalemic Metabolic Alkalosis<br/>3. I-Ultrasound iqinisekisa 'i-Olive' -> IV Saline / Potassium KUFUNEKA ilandele iPyloromyotomy"]
    PatternCheck -->|"Ubudala beenyanga ezi-3 ukuya kwiminyaka emi-3:<br/>I-Cyclic eKhawulezayo Ikhwaza rhoqo nge-15-20 Min Ukutsalela amadolo eSifubeni<br/>+ Pale/Lethargic Phakathi kweSpells +/- Red 'Currant Jelly' Stool"| Intuss["UMrhanela I-ILEOCOLIC INTUSSUSCEPTION<br/>1. Misa ukutya (i-NPO) -> i-diaper yefoto -> Yiya ku-Pediatric ED NGOKUNGOKO<br/>2. I-Ultrasound ibonisa 'Ithagethi / Umqondiso weDonut'<br/>3. Unyangwa ngaphandle kokusikwa ngokuNcitshiswa koMoya oNgxamisekileyo okanye ngeSaline Contrast Enema Reduction"]
    PatternCheck -->|"I-Spitter yobisi oluncinci olungenamzamo emva kokutshiza,<br/>Ukufumana ubunzima okonwabelayo ('Sipitter esonwabileyo')"| Reflux["I-BENIGN PHYSIOLOGICAL GASTROESOPHAGEAL REFLUX (GER)<br/>Gcina ume nkqo 20-30 min emva kokutyisa; ukutya kweebhotile zesantya; ulandelelwano lwesiqhelo lwabantwana"]

Inqanaba loku-1: I-matrix yokuthelekisa enkulu ye-syndromes yokuhlanza iintsana ezi-4

Abazali kunye nabahlengikazi be-triage banokuhlula i-reflux engenabungozi kwizinto ezintathu ezingxamisekileyo zotyando phantsi kwemizuzwana ye-60 ngokujonga ** I-Window ye-Age**, ** Umbala weVomit **, ** I-Appetite After Vomiting , kunye ne- I-Pain / Stool Pattern **:

Uphawu lweklinikhi 1. I-Benign Infant Reflux (GER / "Sipitter esonwabileyo") 2. I-hypertrophic Pyloric Stenosis (HPS) 3. Midgut VolvulusIntestinal Malrotation) 4. Ileocolic Intussusception
Peak Age Window Ukuzalwa ukuya kwiinyanga ezi-6-12 ** ezi-2 ukuya kwiiveki ezi-8 ubudala** (inqabile ukuya kwiiveki ezili-12; 4x ixhaphake ngakumbi kumakhwenkwe amazibulo) 75% kwiintsuku zokuqala ezingama-30 zobomi (90% kunyaka wokuqala, kodwa ingenzeka nakweyiphi na iminyaka) Iinyanga ezi-3 ukuya kwiinyanga ezingama-36 ubudala (incopho 5 ukuya kwiinyanga ezi-9; rhoqo kwiiveki ezi-1 ukuya kwezi-2 emva kwengqele/i-adenovirus okanye i-bug yesisu)
Umbala Wokuhlanza Mhlophe (ubisi olutsha okanye olugotyiweyo) Mhlophe okanye ecacileyo/etyheli (STRICTLY NON-BILIOUS) ngenxa yokuba ibloko ingaphezulu * kwetyhutyha lenyongo Ilikalika ELIQHELEKILEYO OKANYE IHLATHI ELIMNYAMA-LULUHLAZA (BILIOUS) kuba ukujija ku ngaphantsi kombhobho wenyongo Iqala mhlophe/mthubi (imixholo yesisu) kwaye ijike iluhlaza luhlaza emva kwexesha njengoko uthintelo luqhubeka
Amandla okugabha Ukuchwechwela okanye ukugqobhoza okuphuma emlonyeni Ubundlobongela "iProjectile" Arc ukudubula 30 ukuya kwi-90 yeesentimitha (1 ukuya kwi-3 iinyawo) ngapha kwebhedi kanye emva kokutya Okunyanzeliswayo okanye umzamo oqhubekayo we-emesis eluhlaza Ukugabha okwethutyana kwenzeka ngexesha okanye kanye emva kokukhala kwamaza abuhlungu
Njani usana oluqhuba kanye emva kokugabha Ukonwaba, ukuncuma, ukukhululeka, ukutyeba ngokuqhelekileyo "I-Vomiter eHlubileyo": Iingcambu kwaye ikhale ngokukhawuleza ukusela enye ibhotile egcweleyo kanye emva kokulahla (de kungene emva kokuphelelwa ngamanzi emzimbeni / alkalosis) Ukugula, ukucaphuka, ukungathuthuzeleki, okanye ukutyhafa ngokukhawuleza/othukile; uyala ukutya I-Cyclic Paroxysms: Iyakhala kwaye itsale amadolo esifubeni kangangemizuzu emi-2-5, emva koko ijike ** iphatshi, ibile, kunye neyoyikeka/ ibuhlungu kangange-15-20 min** phambi kwamaza alandelayo.
Isitulo kunye neNkangeleko yediaper Izitulo zeentsana eziqhelekileyo ezityheli/ezimdaka ngebala "Izitulo zendlala": Zikhuphe ilindle elinqatyisiweyo ngenxa yokuba akukho lubisi ludlula kwipylorus; progressive Dry diapers Isitulo esincinci okanye isitulo esinegazi elimnyama (hematochezia) xa udonga lwamathumbu luba yi-ischemic (uphawu lwasemva kwexesha/ olubalulekileyo) I-Classic "I-Currant Jelly" Isitulo (igazi elibomvu elimnyama elixutywe ne-sloughed intestinal mucus; qaphela olu luphawu LATE olubonwa kuphela kwi-30-50% yamatyala)
Impawu zeMviwo zesisu Isisu esithambileyo, esingathambanga Iyabonakala ukusuka ukuya ekunene kwegastric wave peristaltic ngaphaya kwesisu esingaphezulu emva kokutyisa + ifemu ephathekayo ** "Ubunzima" bobunzima** kwiquadrant yasekunene ephezulu Kwangoko, isisu sinokujongeka ngokukhohlisayo sicaba/i-scaphoid, emva koko siye sijike, siqine, kwaye sithambile njengee-infarcts zamathumbu. Iphathekayo "Ubunzima obububume besoseji" kumntla wasekunene/embindini wesisu + umzantsi ongenanto wasekunene (Dance's Sign)

Inqanaba lesi-2: Ukuntywila nzulu 1, Ukugabha kweBilious (Luhlaza) kunye neMidgut Volvulus (Iwotshi yeeyure ezi-6)

Kutheni le nto wonke ugqirha wabantwana emhlabeni elahla yonke into kwaye abaleke kwiSebe likaxakeka xa usana olusanda kuzalwa okanye usana luhlanza ulwelo oluluhlaza?

1. I-Anatomy ye-Malrotation kunye ne-Midgut Volvulus

Ngexesha lokukhula okuqhelekileyo kombungu (Iiveki yesi-6 ukuya kweye-10 yokukhulelwa), amathumbu omntwana ajika ajike ama-270 ngokunxamnye newotshi aze abambelele ngokukhuselekileyo kuqhina olubanzi lwediagonal.the mesentery) ukusuka kwisisu esiphezulu ekhohlo (Ligament of Treitz) kumazantsi esisu sasekunene (cecum). - Kumntwana omnye kwabangama-500 abazalwayo (Intestinal Malrotation): Oku kujikeleza kumisa embindini. Endaweni yokuba i-ankile ngaphaya kwesiseko esibanzi, esizinzile, amathumbu amancinci onke axhonywe kudonga olungasemva lwesisu kwi-*phepha-elincinci, isiqu esincinci esiqulethe i-Superior Mesenteric Artery.SMA) kunye nomthambo (SMV), ngelixa iibhanti zefibrous ezingaqhelekanga (Ladd's bands) ukuwela kwi-duodenum. - Ukujija (Midgut Volvulus): Ngawo nawuphi na umzuzu, ngokuqhelekileyo kwiiveki ezi-4 zokuqala zobomi, amathumbu amancinane angabanjwanga anokujijwa njengetawuli ekrunekileyo.360 to 720 degrees) ujikeleze eso sikhondo sicutheneyo semithambo. - Iintlekele ezimbini ngaxeshanye: 1. Ukuvalwa kweDuodenal (Bilious Vomiting)**: Lo mjikelo ujijekileyo ucinezela i-duodenum uvale nje ngaphantsi kombhobho wenyongo, nto leyo enyanzela inyongo eluhlaza eqaqambileyo ibuyele ngasemva esiswi ize iphumele emlonyeni wosana. 2. **Uqhathwa kweMesenteri(Total Midgut Necrosis)**: I-twist ikrwitsha **I-perior Meseeric Vein kunye ne-Artery** ibonelela **i-100 ekhulwini lamathumbu amancinci (jejunum and ileumkunye nesiqingatha samathumbu amakhulu**. Ukuba ayijikajikanga ngotyando (klzxh:0025) kwiiyure ezi-2 ukuya kwezi-6, amathumbu amancinanemntwana wonke ayafa, nto leyo ekhokelela ekubulaweni kwe-septic shock okanye ubomi bonke I-Short Bowel Syndrome efuna isondlo esisisigxina kwi-intravenous (TPN).

2. Kutheni iVovulus yangethuba inokukhohlisa Abazali kunye noGqirha (The Flat-Belly Trap)

  • Kwi-iyure ezi-1 ukuya kwezi-4 ze-midgut volvulus, umqobo uphezulu kwi-duodenum, ngoko ke isisu somntwana sisoloko sisicaba kwaye sithambile (asidumbanga), kwaye usana lusenokubonakala lukhululekile xa luphakathi kokugabha okuluhlaza.
  • Ukulinda isisu esidumbileyo, isisu esiqinileyo okanye ilindle elinegazi lilinde ixesha elide: Isisu esiqinileyo, esithe qelele, umbala obomvu/omfusa wolusu lwesisu, i-tachycardia, kunye nelindle elinegazi kuthetha ukuba amathumbu sele eqalisile ukungena (fa). Isiqendu esinye seyenyani yebilious emesis eluhlaza kumntwana sigunyazisa isithuthi esingxamisekileyo esikhawulezileyo.

Isigaba 3: I-Deep dive 2, i-Hypertrophic Pyloric Stenosis (HPS kunye neProjectile Vomiting)

Ukuchaphazela ** i-2 ukuya kwi-3.5 kuzo zonke iintsana eziyi-1,000 , ngokuqhelekileyo ** iintsana ezizibulo phakathi kwe-3 kunye neeveki ze-6 ubudala ** (kunye nomngcipheko ophezulu ukuba ubonakaliswe kwi-antibiotics ye-macrolide efana ne-erythromycin okanye i-azithromycin kwiiveki ezimbini zokuqala zobomi), ** I-Hypertrophic Pyloric Stenosis (HPS) kukujiya komatshini okuqhubela phambili kweringi yesihlunu esisetyhula ekuphumeni kwesisu (the pyloric sphincter).

1. Uyixelela njani iProjectile Pyloric Stenosis Ngaphandle kweReflux eqhelekileyo okanye ukunganyamezeli kweFomula

  1. Ukunyuka "koNyanzelo kunye nokuMgama" Ngaphezulu kweentsuku ezi-3 ukuya kwezisi-7:
  2. Ihlala iqala malunga neeveki ezi-3 ubudala** ijongeka njengokutshicela ngamandla, emva koko inyuke ngokukhawuleza de isondlo ngasinye siphele ngeumthombo onjengeprojectile ejection yobisi olumhlophe, olugotyiweyo, olunuka muncu (ngamanye amaxesha lunamachaphaza anobumdaka obuncinci "umhlaba wekofu" ukusuka kuluhlu olucaphukisayo lwesisu, 300 imitha yebilee eluhlaza30 idubule ibilebile yesisu30 imitha eluhlaza (inyawo ezi-1 ukuya kwezi-3)** zidlule kwiinzwane zosana.
  3. Indlela Yokuziphatha "Yokugabha Olambileyo":
  4. Ngokungafaniyo nosana olunentsholongwane yesisu okanye i-bowel twist (oziva enesicaphucaphu aze angayifuni ibhotile), usana olunepyloric stenosis lunengqondo ephilileyo kunye namathumbu asoloko elambile ngenxa yokuba ukutya akukwazi ukudlula kwisango lesisu esijiyileyo. Ngephanyazo umntwana ugqiba ukugabha, zisuka iingcambu esifubeni sakho zikhale ngomsindo zifuna ukutyiswa kwakhona.
  5. **Okubonakalayo "Ibhola yegalufa yePeristaltic Wave" Emva kokutyisa **:
  6. Ukuba utyhila isisu somntwana wakho phantsi kwesibane kanye emva kokuba esele ubisi (phambi kokuba agabhe), unokubukela amaza acothayo, anesingqi amaza ajongeka ngathi yibhola yegalufa eqengqeleka ngaphantsi kolusu ukusuka kwiimbambo zasekhohlo ukuya kumbindi wesisu wasekunene njengoko isisu sisimka kwipylorus evalekileyo.

2. Umgaqo weSibhedlele oBalulekileyo: Kutheni i-Pyloric Stenosis i-Medical yokuvuselela iNgxamiseko ngaphambi kokuba ibe yiNgxakeko * yoCando *

Abazali badla ngokumangaliswa xa ugqirha wotyando esithi: “Sifumene iPyloric Stenosis kwiultrasound kwimizuzu eli-10, kodwa ASIYI kuthabatha usana lwakho siluse kwigumbi lotyando kangangeeyure ezili-12 ukusa kwezingama-24.” * Nasi isizathu sokuba oko kulibaziseka kusindisa ubomi bomntwana wakho: - I-Hypochloremic, Hypokalemic Metabolic Alkalosis: Ngalo lonke ixesha usana lwakho lugabha iasidi ecocekileyo yesisu (\(\text{HCl}\)), umzimba wabo ulahlekelwa yizixa ezikhulu ze- Hydrogen ions (\(\text{H}^+\)), Chloride (\(\text{Cl}^-\)),**,Sodium,\(+,***,Isodium,\)+ Ukubambelela emanzini, izintso zomntwana zilahla i-Potassium exabisekileyo (\(\text{K}^+\))* kwaye igcine Bicarbonate (\(\text{HCO}_3^-\)), ijika igazi lomntwana ngokuyingozi ialkaline (Metabolic Alkalosis). - I-Post-Anesthesia Apnea Risk: Ngenxa yokuba i-bicarbonate yegazi ephezulu (\(\text{HCO}_3^- > 30\text{ mEq/L}\)) ikhohlisa iziko lokuphefumla lengqondo yomntwana ukuba ihlise ukuphefumla (ukugcina i-acidic \(\text{CO}_2\)), ibeka i-un-resuscitated ibangela usana oluphantsi kwe-anesthesia jikelele (ukuyeka ukuphefumla emva kotyando)** kunye ne-cardiac arrhythmias esuka kwi-potassium ephantsi. - I-Safe Protocol: Iqela labantwana kuqala linika 12 ukuya kwiiyure ezingama-24 emithanjeni 0.9% Normal Saline + Dextrose + Potassium Chloride de i-serum chloride ibe yi-\(> 100\text{ mEq/L}\), i-bicarbonate yi-\(< 28\text{ mEq/L}\), kwaye umntwana wenza ama-diapers amanzi, kwaye emva koko enze i-15-minute Laparoscopic Ramstedt Pyloromyotomy* (ukwahlula i-babis evulekileyo ngaphandle kweeyure zokuhlinzwa ngokusisigxina kwi-babi yesisu ngokusisigxina).

Inqanaba lesi-4: Ukuntywila nzulu 3, i-Intussusception (Ithumbu leTelescoped kunye ne'Currant Jelly' Stool)

I-Intussusception yi-#1 unobangela wokuphazamiseka kwamathumbu abukhali kwiintsana kunye nabantwana abaselula phakathi kweenyanga ezi-3 kunye ne-3 yeminyaka ubudala* (ukuphakama phakathi kwe-5 kunye neenyanga ezi-9). Kwenzeka xa inxalenye esondeleyo yamathumbu amancinci (the ileum) ukugoba kunye nezilayidi ngaphakathi kwamathumbu amakhulu akufuphi (the cecum/colon) kanye njengeteleskopu yepirate edilikayo okanye ikawusi ejikelwe ecaleni ngaphakathi ngaphandle.

1. Kutheni i-Intussusception Yenzeka Emva kweNqele eqhelekileyo, iBug yesisu, okanye iLymph Node Ukudumba

Kwiimeko ezingama-90 ekhulwini zeentsana (idiopathic ileocolic intussusceptionUsulelo lwamva nje lwentsholongwane yokuphefumla (adenovirus) okanye i-viral gastroenteritis ibangela ukuba amabala e-lymphatic aqhelekileyo ngaphakathi kulwelwesi lwe-ileum terminal (Peyer's patches) adumbe okweetoni ezidumbileyo. Ukucudisa ngokwesiqhelo kwamathumbu (peristalsis) ibamba i-lymph patch edumbileyo (the lead point) kwaye itsalela amathumbu amancinane kanye ngaphakathi kwikholoni, irhuqa eyakhe imithambo yegazi (mesentery) kwimikhono eqinileyo nayo.

2. I-Classic Clinical Triad (kwaye kutheni ungaze ulinde isitulo)

Iincwadi zezifundo zifundisa i-triad yakudala ye- **I-Colicky Abdominal Pain + Palpable Sausage Mass + I-Red "Currant Jelly" Stool **, kodwa ngaphantsi kwe-30 yeepesenti zeentsana zineempawu ezintathu xa zifika kuqala kwiSebe likaNgxamiseko:

  1. Umqondiso woku-1 (ukhona kwi-85-90%): Ngequbuliso, i-Paroxysmal "idolo-isifuba" i-Screaming Waves rhoqo nge-15 ukuya kwi-20 yeMizuzu:
  2. Usana obeludlala okanye lulele ngesiquphe lukhupha isikhalo esihlabayo, esibuhlungu, lujike luphaphatheke, lubile, luze luwatsale amadolo omabini abambelele emazantsi esisu kangangemizuzu emi-2 ukuya kwemi-5** njengoko ukufinyela kweperistaltic kucudisa amathumbu eteleskopu.
  3. Emva koko i-contraction iyayeka, kwaye umntwana uyayeka ukukhala ngokukhawuleza.
  4. Umqondiso wesi-2 (Owona Mngxunya unobungozi kakhulu): I-Profound Post-Spasm Lethargy / "Stroke-like" Floppiness:
  5. Ngexesha le-15-to-20-minute intervals between pains spasms, imithambo ye-mesenteric ecinezelekileyo ikhupha i-opioids engapheliyo kunye nabalamli abadumbileyo ezenza usana lungabi naluhlu, lube namehlo eglasi, luphaphathekile, luphumle, okanye lube nefloppy ngokupheleleyo**. Enyanisweni, ** i-10 ukuya kwi-15 yeepesenti zeintsana ezine-intussusception zikhoyo ngokukrakra okunzulu kunye nesimo sengqondo esitshintshileyo * ngaphandle kokukhala okucacileyo **, ekuqaleni kujonge njenge-sepsis okanye i-meningitis.
  6. Umqondiso wesi-3 (Uphawu lwamva lwe-Mucosal Venous Congestion): Isitulo se-"Currant Jelly":
  7. Njengoko umkhono wamathumbu ongaphakathi udumba, igazi le-venous alikwazi ukubaleka ngelixa igazi le-arterial lihlala limpompa ngaphakathi. Amathumbu axineneyo alila igazi elimnyama le-venous elixutywe ne-mucus eshinyeneyo ye-goblet-cell, livelisa ilindle elikhangeleka ngathi ijeli yecurrant emnyama emnyama okanye ijem yeraspberry.
  8. UMGAQO OBALULEKILEYO: Ilindle elithi "currant jelly" lithetha ukuba ulwelo lwamathumbu sele luxinene kwaye lopha. Yiya kuPediatric ED kwinqanaba le-cyclic edolo-to-esifubeni ekhala + ukuphelelwa ngamandla/ukugabha, iiyure ngaphambi kokuba kuvele ilindle elinegazi.

3. OoGqirha Bayilungisa Njani I-Intussusception Ngaphandle Kokuphi na Utyando (The Air or Saline Enema)

Ukuba uzisa umntwana wakho kwiSebe leeNgxamiseko zaBantwana kwangoko (kwiiyure zokuqala ezili-12 ukuya kwezingama-24, phambi kokugqobhozwa kwamathumbu): - I-Diagnostic Ultrasound (100% Radiation-Free): Ithatha imizuzu emi-5 kwaye ityhila into engaqondakaliyo "Uphawu ekujoliswe kulo" / "Uphawu lweDonut" / "Uphawu lwe-Bull's-Eye" (amakhonkco agxininise amathumbu ngaphakathi kwamathumbu) kwindawo enqamlezileyo. - **I-Non-Surgical Pneumatic (Air) okanye i-Hydrostatic (Saline) Contrast Enema Reduction **: Kwi- **85 ukuya kwi-90 yeepesenti yeemeko **, akukho nto ifunekayo yokuhlinzwa. Ngaphantsi kwe-ultrasound yexesha lokwenyani okanye isikhokelo se-fluoroscopy, i-radiologist yabantwana ibeka i-catheter ethambileyo ngobunono kwi-rectum kwaye ingenise elawulwa uxinzelelo lomoya (\(\le 120\text{ mmHg}\)) okanye i-saline eshushu ethi ityhale ngobunono ileum yeteleskopu ngasemva ngaphandle kwekholoni ngemizuzu emi-3, inika umntwana isiqabu ngoko nangoko. (Qaphela: kwi-5 ukuya kwi-10 yepesenti yabantwana, amathumbu angaphinda abone i-telescope kwiiyure zokuqala ezingama-24 ukuya kwezingama-48 ngelixa i-Peyer's patch isadumba, ngoko jonga ngokufutshane emva kokukhutshwa kwayo nayiphi na imbuyekezo ye-cyclic cramping).

Isigaba 5: Ezinye izinto ezibeka ubomi emngciphekweni zokugabha kunye nokukhala kosana (Incarcerated Inguinal Hernia, Testicular Torsion, kwaye Cow's Milk Protein Enterocolitis / FPIES)

Nanini na xa umntwana okanye umntwana oselula ekhala ngesiquphe engathuthuzelekiyo kunye nokuhlanza ngamandla, oogqirha bengxakeko yabantwana bahlala bekhulula i-diaper ngokupheleleyo ukujonga ** iimeko ezimbini ezingxamisekileyo ze-anatomical zangaphandle ** kunye ** enye i-protein shock shock syndrome enye ** exelisa ngokusondeleyo intussusception kunye ne-pyloric stenosis:

1. Ukuvalelwa okanye ukuKrwitshwa kweInguinal Hernia (Always Check the Diaper Crease)

Ukuchaphazela ** i-1 ukuya kwi-5 ipesenti yeentsana ezipheleleyo ** kunye ne- ** 10 ukuya kwi-30 yeepesenti zeentsana ezizalwa ngaphambi kwexesha ** (amaxesha angama-8 axhaphake kakhulu kumakhwenkwe, nangona kubonwa kumantombazana apho i-ovary ingakwazi ukukhupha kwi-canal ye-Nuck), ** i-hernia inguinal ** iyenzeka xa i-loop ye-intestine encinci ivalekile (i-congenital i-tunnel ivalwe nge-tunnel ye-tunnel).patent processus vaginalis) kwi-groin crease okanye kwi-scrotum. - Yintoni ebonwa ngabazali xa i-diaper iphuma : - Igaqa eliqinileyo, elixineneyo, elingacinezelekiyo okanye ukudumba kwi-groin crease (okanye kwelinye icala le-scrotum/labia) elingatshoni libe mcaba xa umntwana eyeka ukukhala, edla ngokujikabomvu, abemfusa, okanye athambe ngendlela engathethekiyo xa ebamba*. - Ngenxa yokuba i-loop ye-pinched of bowel ivalwe ngokupheleleyo ngaphakathi kweringi ye-inguinal eqinile, umntwana ukhula i-paroxysmal screaming, i-abdominal distension, kunye nokugabha ngamandla (okujika ibilious green). - Inyathelo elikhawulezileyo: - UNGAZE uzame ukutyhala iqhuma eliqinileyo, elibomvu, okanye elithambileyo libuyele ngaphakathi kwakho ekhaya (risk of rupturing ischemic bowel or reducing dead bowel en masse). Yiya kwiSebe leeNgxamiseko zaBantwana ngoko nangoko ukuze ugqirha wabantwana akwazi ukuthoba ngesandla (taxis) ngaphakathi kwefestile ye-6 yeyure yokusebenza phambi kokuba i-bowel okanye i-testicular infarction yenzeke.

2. UkuTshiswa kwamasende oSana okanye kuSatana

Kwiintsana zamadoda, ukujijeka kwentambo yespermatic (testicular torsion) kubangela isicaphucaphu, ukugabha ngamandla, kunye nokukhala ngequbuliso apho usana luyitsalela phezulu imilenze yalo, ngokulula kuphazanyiswe yi-colic okanye intussusception ukuba idiaper ihlala ibotshiwe. - UkuJonga okuSinyanzelo sokuSetyenziswa kwe-Diaper: Ngalo lonke ixesha jonga amacala omabini esingxobo se-scrotum ngexesha lokukhala komntwana ngesiquphe okanye xa kukho ingxaki yokugabha. Ukuba elinye icala lesingxobo se-scrotum ** lidumbile, liqinile, likhwele phezulu, okanye bubluish-bomvu**, phuthuma kwiSebe likaNgxamiseko ngokukhawuleza (i-testicular salvage ihla ngokukhawuleza emva kwe-*4 ukuya kwiiyure ze-6 ** ye-ischemia).

3. I-Acute Food Protein-Induced Enterocolitis Syndrome (FPIES) vs. Ukuthintelwa ngotyando

Kuthekani ukuba usana oluneenyanga ezi-2 ukuya kwi-9 ubudala luqala ** ukuphindaphinda, ukugabha okugqithisileyo kweyure enye ukuya kwezi-4 emva kokuzama ukutya okutsha ** (idla ngokuba yifomyula yobisi lwenkomo, i-soy, i-oats, i-rice cereal, iqanda, okanye ibhanana) kwaye ngokukhawuleza ibe ** iqhwala, ibala, i-ahen-grey, kunye ne-hypothermic**? - Acute FPIES: Ukusabela kwe-non-IgE cell-mediated gastrointestinal hypersensitivity ebangela utshintsho olukhulu lwamanzi kwi-lumen yamathumbu.third-spacing), kubangela ** i-15 ukuya kwi-20 yeepesenti zeentsana ukuba zibonise kwi-hypovolemic shock enzulu ** ebonakala ifana ne-sepsis, intussusception, okanye i-volvulus. - Ulawulo oluNgxamisekileyo: Nokuba uyakrokra FPIES ukusuka ekutyeni okutsha okwaziswe kwiiyure ezi-2 ngaphambili, ** yiya kwiSebe likaxakeka ngokukhawuleza **. Ibukhali FPIES ifuna ngokukhawuleza umthambo oqhelekileyo we-saline boluses (20 mL/kg) kunye nemithambo okanye i-ondansetron yomlomo (Zofran) ukumisa ukugabha okuqhutywa yicytokine nokuthintela ukothuka.

Uluhlu lokuhlola ikhaya: ukuphelelwa ngamanzi emzimbeni kosana kunye neeflegi ezibomvu ezothusayo

Nanini na xa usana lugabha ngokuphindaphindiweyo, jonga ezi 5 Hydration & Perfusion Markers phambi naxa uthuthwa ukuya esibhedlele:

  • ** Bala i-Diapers ezimanzi kwi-12 yokugqibela kwiiyure ze-24 **: Usana olune-hydrated phantsi kweenyanga ze-6 kufuneka luvelise ** ubuncinci i-diapers emanzi e-6 enzima kwiiyure ezingama-24 ** (ubuncinci i-diaper ye-1 emanzi rhoqo kwiiyure ezi-4 ukuya kwezi-6). Ukuhamba ** ngaphezu kweeyure ezi-6 kunye ne-diaper eyomileyo yamathambo ** (okanye iikristale ezimnyama ezi-orenji / ezipinki ezinothuli lwezitena kwi-diaper) kubonisa ukuphelelwa ngamanzi emzimbeni.
  • Jonga i-Anterior Fontanelle ("Indawo ethambileyo" Phezulu kweNtloko): Xa ubanjwe ngokuzolileyo kwindawo ehleli nkqo, indawo ethambileyo emile okwedayimani phezu kwentloko yosana kufuneka ivakale ithe tyaba kwaye ithambe. A etshone nzulu, indawo ethambileyo egobileyo ibonisa ukwehla komthamo wolwelo ophakathi ukuya kobukhali (ngelixa ifonti eqinile, eqhumayo ibonisa uxinzelelo oluphezulu lwe-intracranial/meningitis).
  • Jonga Iinyembezi, Ukufuma koMlomo, kunye neNkangeleko yamehlo: Baleka umnwe ococekileyo ngaphakathi esidleleni somntwana: kufuneka zive ukutyibilika ngamathe amanzi. Ulwimi ** olomileyo, oluncangathi, olomileyo**, ukukhala ngaphandle kweenyembezi ezimanzi, kunye amehlo atshonileyo, abomvu krwe abonisa \(\ge 5\text{ ukuya }10\%\) dehydration.
  • Vavanya ukuZaliswa kwakhona kweCapillary esembindini kunye neperipheral (The 2-Second Sternum Press): Cinezela umnwe wakho ngobunono kumbindi wethambo lomntwana (sternum) okanye uzwane olukhulu imizuzwana emi-3 de ulusu lube mhlophe, emva koko uyeke: umbala opinki kufuneka ugungxule ngasemva ngaphantsi kwemizuzwana emi-2*. Ixesha lokuzaliswa kwakhona kwe- **3 imizuzwana okanye ngaphezulu **, okanye i-mottled, i-cool extremities, ibonisa ukothuka kwe-hypovolemic.
  • Jonga iPhatheni yokuphefumla: Ukuphefumla ngokukhawuleza, ukuphefumla okunzulu (Kussmaul respirationsIbonisa i-metabolic acidosis ebukhali evela kukuphelelwa ngamanzi emzimbeni okanye kwi-ischemia yamathumbu, ngelixa ukucotha ngokungaqhelekanga, ukuphefumla okunzulu kunokwenzeka kwi-alkalosis enzima yemetabolism (pyloric stenosis).

Tip

Ngalo lonke ixesha gcina ithemometha yedijithali, amalaphu acocekileyo, kunye nedilesi yeSibhedlele saBantwana esikufuphi sakho / iSebe eliMiselweyo likaNgxamiseko lwaBantwana* egcinwe kwifowuni yakho. Xa usana lunotyando oluluqilima lwesisu, lusiya ngqo kwiziko labantwana elingaphakathi endlwini Pediatric Ultrasound kunye ne Utyando lwaBantwana luthintela ukujongwa kwemitha ye-CT scan yabantu abadala kwaye kucuthwe ixesha lokhathalelo oluqinisekileyo kwisiqingatha. Cinga ngokuthatha izandla ** kwi-Infant & Child First Aid kunye nekhosi ye-CPR ** kwi-Red Cross, i-American Heart Association, okanye i-St John Ambulance.

Imibuzo edla ngokubuzwa

Uthini umahluko phakathi komhlanzo omthubi kunye nomhlanzo oluhlaza (obilious) emntwaneni?

Ukugabha okumthubi okanye ibhotolo kuvela kumafutha obisi aqhelekileyo, umthubi, okanye ulwelo lwesisu olungaphezulu kombhobho wenyongo kwaye luxhaphakile kwi-benign reflux okanye izinambuzane zesisu. I-lime-green ekhanyayo, i-highlighter-green, okanye ihlathi elimnyama-luhlaza (bilious) uhlanzo luqulethe i-bile bile ephuma emathunjini ngaphantsi kwesisu kwinxalenye yesibini ye-duodenum. Ukuba inyongo eluhlaza iphuma emlonyeni wosana, oko kuthetha ukuba amathumbu avaleleke ngokwasemzimbeni ngaphantsi kombhobho wenyongo, ngokuyingozi kakhulu ukusuka kwi-Intestinal Malrotation eneMidgut Volvulus, apho amathumbu amancinane onke ajijeka ajikeleze umthambo wawo ongundoqo kwaye anokufa kwiiyure ezi-2 ukuya kwezi-6. Nakuphi na ukuhlanza okuluhlaza kwintsana kufuna uhambo olukhawulezayo ukuya kwigumbi likaxakeka.

Ndingawubona njani umahluko phakathi kokutshica komntwana okuqhelekileyo kunye nokugabha okuphuma kwi-pyloric stenosis?

I-reflux eqhelekileyo ye-physiological ("ukutshica okumnandi") yenzeka ngokukhawuleza ngexesha okanye kanye emva kokubhoboza, iqengqeleka kancinci esilevini okanye esifubeni somntwana, kwaye usana luhlala lukhululekile kwaye lutyeba ngokuthe ngcembe. I-Hypertrophic pyloric stenosis ngokuqhelekileyo iqala phakathi kweeveki ezi-2 kunye ne-8 ubudala kwaye ibangela ukuqhubeka, uxinzelelo oluphezulu lokugabha apho lonke ubisi olumhlophe, olungenayo i-bilious ludubula kwi-arc 30 ukuya kwi-90 yeesentimitha (1 ukuya kwi-3 iinyawo) kude nomlomo womntwana, kulandelwa ngokukhawuleza usana olukhala ngokukrakra, ukuhlafuna kwakhona ". amanapkeni.

Kutheni usana olune-intussusception lubonakala lulala okanye lusebenze ngokufanelekileyo kwimizuzu eyi-15 phakathi kokukhala?

Kwi-intussusception, icandelo elinye lamathumbu lityibilika ngaphakathi kwelinye njengeteleskopu. Rhoqo kwimizuzu eli-15 ukuya kwengama-20, igagasi lendalo lokufinyela kwemisipha yamathumbu (i-peristalsis) licudisa izibilini zangaphakathi ezivaleleke ngaphakathi kunye nemithambo yegazi exineneyo, nto leyo ebangela imizuzu emi-2 ukuya kwemi-5 yeentlungu ezibuhlungu ze-colic apho usana lukhala luze lutsale amadolo omabini esifubeni. Xa eliza le-peristaltic liphumla, ukucudisa kunqumama ngokukhawuleza kwaye amathumbu acinezelekileyo akhupha amanqanaba otyando e-endogenous opioids (endorphins) kunye ne-autonomic vagal signals eyenza usana lubukeke luzolile ngendlela eyothusayo, luphaphathekile, ludiniwe, okanye lutyhafile de ukufinyela okulandelayo kufike emva kwemizuzu eli-15.

Ngaba usana olune-intussusception okanye i-pyloric stenosis luhlala lufuna utyando olukhulu oluvulekileyo lwesisu?

Hayi. Kwi-ileocolic intussusception ebanjwe kwangethuba phambi kokugqobhozwa kwamathumbu, ama-85 ukuya kuma-90 ekhulwini abantwana banyangwa ngaphandle kokusikwa kotyando konke konke kusetyenziswa imizuzu emi-5 ye-ultrasound- okanye i-X-ray-guided Air okanye i-Saline Enema kwi-suite ye-radiology, ethi ityhale ngobunono amathumbu eteleskopu abuyele endaweni. Kwi-hypertrophic pyloric stenosis, xa ulwelo olufakwa kwi-intravenous lulungisa ukomisa komntwana kunye ne-electrolyte ngaphezu kwe-12 ukuya kwiiyure ezingama-24, oogqirha botyando benza i-laparoscopy ye-laparoscopy encinci ye-pyloromyotomy ngokusebenzisa ama-keyhole ama-3-millimeter amancinci; utyando luthatha imizuzu eli-15 ukuya kwengama-20, yaye uninzi lweentsana luqalisa ukusela ubisi kwiiyure ezi-4 ukuya kwezi-6 luze lugoduke ngosuku olulandelayo.

Imithombo ijongiwe

  • Umbutho waseMelika woCando lwaBantwana (APSA) kunye neAmerican Academy of Pediatrics (AAP, ICandelo loTyando): *Izikhokelo zokuSebenza kweKlinikhi yoVavanyo lwe-Bilious Emesis kwi-Neonate (i-Malrotation kunye ne-Midgut Volvulus), i-Hypertrophic Pyloric Stenosis Resuscitation Targets, kunye ne-Ileocolic Intussusception Reduction *.
  • IKholeji yaseRoyal yeZifundo zaBantwana kunye neMpilo yaBantwana (RCPCH) kunye neZiko leSizwe lezeMpilo kunye nokuGqwesa (NICE, United Kingdom, Isikhokelo NG1 & CG84): Isifo se-Gastro-Oesophageal Reflux kunye neFlegi eziBomvu zoTyando kwiProjekthi kunye nokuGabha okuBilious kwiintsana nakuBantwana.
  • IKholeji yaseMelika yeRadiology (ACR): *Iikhrayitheriya ezifanelekileyo zokuGabha kwiintsana ukuya kwiinyanga ezi-3 zeminyaka (Upper GI Series for Volvulus vs. Ultrasound for Pyloric Stenosis and Intussusception) *.
  • I-World Health Organization (WHO): * I-Pocket Book of Hospital Care for Children: Izikhokelo zoLawulo lweZigulo eziQhelekileyo zobuNtwana kunye ne-Acute Surgical Abdomen *.

Izikhokelo ezinxulumeneyo