Congenital hypertrophic pyloric stenosis

Introduction to congenital hypertrophic pyloric stenosis Congenital hypertrophic pyloric stenosis (CHPS) is a mechanical pyloric obstruction caused by pyloric ring muscle hypertrophy and hyperplasia, which is a common disease in neonates and infants. Most of them are full-term children, and the success of the treatment of pyloric stenosis is one of the great achievements of surgery in this century. There are different morbidity rates depending on geography, seasonality and ethnicity. The European and American countries are higher, about 2.5 to 8.8 , and the Asian region is relatively low. The incidence rate in China is 3 . Mostly male, the ratio of male to female is about 4 to 5:1, and even as high as 9:1. More common in the first child, accounting for 40 to 60% of the total number of cases. There are experiments to give pentagastrin gas to the pregnant dog. As a result, the proportion of pyloric stenosis in the puppies is very high, and it is found that the serum gastrin concentration is relatively high in the third to fourth month of pregnancy, and it is believed that the pregnant woman is In the late pregnancy, due to emotional anxiety, the serum gastrin concentration is increased, and the fetal placenta enters the fetus, and the fetal genetically oriented gene acts to cause long-term obstruction of the pylorus. The pyloric expansion stimulates the G cell to secrete gastrin, thus the disease, but other Scholars repeatedly measured gastrin, some reported increased, and some did not change abnormally. Even in cases with elevated gastrin, it is not possible to infer whether it is the cause or result of pyloric stenosis, because some cases of gastrin in the case 1 week after surgery Return to normal level, and some increase, in recent years, study gastrointestinal stimulating hormone, determine the concentration of prostaglandins (E2 and E2a) in serum and gastric juice, suggesting that the content of gastric juice in children is significantly increased, suggesting that the pathogenesis is pyloric muscle The increase of local hormone concentration in the layer causes the muscles to be in a state of constant tension, which leads to the onset of disease. Some people have studied the serum cholecystokinin, and the results are not abnormal. . The pylorus full-thickness muscle hypertrophy, hyperplasia, with ring muscles, muscle fiber thickening and connective tissue proliferation between muscle bundles, hypertrophic muscle tissue gradually migrates to the normal stomach wall, on the duodenum side, due to the gastric wall muscle layer and The muscular layer of the duodenal wall does not continue, so the hypertrophy suddenly terminates at the beginning of the duodenum, making the pylorus a spindle-shaped mass, 2 to 3 cm long, 1.5 to 2 cm in diameter, and 0.4 to 0.6 cm thick in muscle layer. The surface is pale and smooth, firm like cartilage, and the mass increases with age. The hypertrophic muscle layer pushes the mucosa inward and forms wrinkles, causing stenosis of the pyloric lumen, resulting in incomplete obstruction, obstruction of gastric emptying and enhanced gastric peristalsis. The stomach wall is thickened, and the stomach is dilated. On the side of the duodenum, the pyloric tube is partially pushed into the duodenal bulb due to strong gastric peristalsis, and the duodenal mucosa is reflexed into a cervical-like pyloric obstruction. After that, the retention of milk juice stimulates the gastric mucosa to produce congestion and edema (Figure 1). basic knowledge The proportion of illness: 0.0025% Susceptible people: infants and young children Mode of infection: non-infectious Complications: Dehydration Muscular Dystrophy

Causes of congenital hypertrophic pyloric stenosis

(1) Causes of the disease

In order to clarify the etiology and pathogenesis of pyloric stenosis, a lot of research work has been carried out over the years, including pathological examination, establishment of animal models, detection of gastrointestinal hormones, virus isolation, genetic research, etc., but the cause is still inconclusive.

Genetic factor

It plays an important role in the etiology. The disease has obvious familial characteristics. Even a mother and 7 sons are sick, and the single-oval twins are more common than the double-oval twins. The parents have a history of pyloric stenosis. The incidence rate can be as high as 6.9%. If the mother has this history, the probability of her child disease is 19%, and her female is 7%. The father has a history of 5.5% and 2.4%, respectively. After study, the pyloric stenosis is indicated. The genetic mechanism is polygenic, neither recessive nor non-sexual, but a directed genetic gene consisting of a dominant gene and a sexually modified multifactor, which is influenced by certain environmental factors. Such as social class, diet, various seasons, etc., the incidence of high incidence in spring and autumn, but the relevant factors are unknown, common in high-weight male infants, but has nothing to do with the length of gestational age.

2. Neurological function

Researchers who are mainly engaged in the pyloric myenteric plexus have found that ganglion cells do not mature until 2 to 4 weeks after birth. Therefore, many scholars believe that neuronal dysplasia is the mechanism that causes pyloric muscle hypertrophy, and negates the past pyloric ganglia. The theory of cell degeneration leading to lesions, using histochemical analysis to determine the activity of enzymes in the pyloric ganglion cells; but there are also dissidents, ganglion cells with pyloric stenosis are observed to have no similarities with the fetus, such as ganglion cell development Poor is the cause, the premature infants should be more than the full-term children, but there is no difference between them. In recent years, it is suggested that the structural changes and dysfunction of the peptide nerve may be one of the main causes, and the ring muscle is observed by immunofluorescence technique. The number of neuropeptides containing enkephalin and vasoactive intestinal peptide was significantly reduced. Radioimmunoassay was used to determine the decrease of substance P in tissues. It is speculated that the changes of these peptides are related to the pathogenesis.

3. Gatrogen hormones

There are experiments to give pentagastrin gas to the pregnant dog. As a result, the proportion of pyloric stenosis in the puppies is very high, and it is found that the serum gastrin concentration is relatively high in the third to fourth month of pregnancy, and it is believed that the pregnant woman is In the late pregnancy, due to emotional anxiety, the serum gastrin concentration is increased, and the fetal placenta enters the fetus, and the fetal genetically oriented gene acts to cause long-term obstruction of the pylorus. The pyloric expansion stimulates the G cell to secrete gastrin, thus the disease, but other Scholars repeatedly measured gastrin, some reported increased, and some did not change abnormally. Even in cases with elevated gastrin, it is not possible to infer whether it is the cause or result of pyloric stenosis, because some cases of gastrin in the case 1 week after surgery Return to normal level, and some increase, in recent years, study gastrointestinal stimulating hormone, determine the concentration of prostaglandins (E2 and E2a) in serum and gastric juice, suggesting that the content of gastric juice in children is significantly increased, suggesting that the pathogenesis is pyloric muscle The increase of local hormone concentration in the layer causes the muscles to be in a state of constant tension, which leads to the onset of disease. Some people have studied the serum cholecystokinin, and the results are not abnormal. .

4. Muscle functional hypertrophy Some scholars have observed through careful observation that some infants born 7 to 10 days will force the curd block to pass through the signs of the narrow pyloric canal. It is believed that this mechanical stimulation can cause mucosal edema and thickening. On the one hand, it also causes dysfunction of the cerebral cortex to the internal organs, causing paralysis of the pylorus. Two factors cause the pyloric stenosis to form severe obstruction and symptoms, but there are also negative opinions. It is believed that pyloric fistula first causes functional hypertrophy of the pyloric muscle. Appropriate, because the thick muscles are mainly the ring muscles, and the sputum should cause some early symptoms. However, in some cases where the vomiting occurs very early, it is usually found that the mass has formed, and the size of the tumor is not related to the length of the disease. When the muscle hypertrophy reaches a certain critical value, the pyloric obstruction is manifested.

5. Environmental factors

The incidence rate has obvious seasonal peaks, mainly in spring and autumn. In the biopsy tissue sections, there are leukocyte infiltration around the ganglion cells, which may be related to viral infection, but the blood, feces and pharynx of the children and their mothers are detected. The Coxsackie virus was not isolated, and there was no change in serum neutralizing antibodies. No pathological changes were observed in animals infected with Coxsackie virus. The study is continuing.

The main pathological changes are hypertrophy of the pyloric muscle layer, especially in the ring muscle, but also in the longitudinal muscles and elastic fibers. The pylorus is olive-shaped, hard and elastic, and is more rigid when the muscles are paralyzed. ~2.5cm, diameter 0.51cm, muscle layer thickness 0.40.6cm, larger in older children, but the size is not related to the severity of the symptoms and the length of the disease. The surface of the mass is covered with peritoneum and very smooth, but due to blood It is partially blocked because of the pressure, so the color appears pale, the ring muscle fibers increase and hypertrophy, the muscles are like gravel hard, the thick muscle layer squeezes the mucous membranes in vertical shape, makes the lumen narrow, mucous membrane edema, and inflammation occurs later. The lumen is made smaller. On the autopsy specimen, the pylorus can only pass the 1mm probe. When the narrow pyloric tube moves to the antrum, the cavity gradually tapers and the hypertrophic muscle layer becomes thinner. There is no precise boundary between the two, but the boundary of the duodenum is obvious. Because the muscularis of the stomach wall is not continuous with the muscle layer of the duodenum, the hypertrophic pyloric mass suddenly terminates and protrudes into the duodenal cavity. Shaped like a cervical-like structure, Histological examination showed muscular hyperplasia, hypertrophy, muscle fiber disarray, mucosal edema, hyperemia.

Due to pyloric obstruction, proximal gastric dilatation, wall thickening, increased mucosal folds and edema, and due to retention of gastric contents, often lead to mucosal inflammation and erosion, and even ulcers.

(two) pathogenesis

The pylorus full-thickness muscle hypertrophy, hyperplasia, with ring muscles, muscle fiber thickening and connective tissue proliferation between muscle bundles, hypertrophic muscle tissue gradually migrates to the normal stomach wall, on the duodenum side, due to the gastric wall muscle layer and The muscular layer of the duodenal wall does not continue, so the hypertrophy suddenly terminates at the beginning of the duodenum, making the pylorus a spindle-shaped mass, 2 to 3 cm long, 1.5 to 2 cm in diameter, and 0.4 to 0.6 cm thick in muscle layer. The surface is pale and smooth, firm like cartilage, and the mass increases with age. The hypertrophic muscle layer pushes the mucosa inward and forms wrinkles, causing stenosis of the pyloric lumen, resulting in incomplete obstruction, obstruction of gastric emptying and enhanced gastric peristalsis. The stomach wall is thickened, and the stomach is dilated. On the side of the duodenum, the pyloric tube is partially pushed into the duodenal bulb due to strong gastric peristalsis, and the duodenal mucosa is reflexed into a cervical-like pyloric obstruction. After that, the retention of milk juice stimulates the gastric mucosa to produce congestion and edema (Figure 1).

Congenital hypertrophic pyloric stenosis prevention

Drinking water or milk before the test, and the right lateral position is the best way to rule out the gas in the stomach cavity.

Experts suggest: this disease is congenital digestive tract malformation, no effective preventive measures, drug treatment can not correct the deformity, early detection and early treatment is the key to prevention and treatment, so it is necessary to go to the hospital as soon as possible to perform pyloric ring muscle incision, the effect is better.

Congenital hypertrophic pyloric stenosis complications Complications Dehydration Muscular Dystrophy

1 dehydration is severe, lack of body fluids

2 electrolyte disorder: alkali poisoning, breathing shallow and slow, and may have symptoms such as throat and hand, foot and ankle, after the kidney function is low, acidic metabolites are retained in the body, some alkaline substances are neutralized, so there is little obvious alkalosis By.

3 nutritional disorders: lower than the body needs.

4 There is a danger of suffocation.

5 There is a risk of infection after surgery.

Congenital hypertrophic pyloric stenosis symptoms Common symptoms Loss of water, dehydration, pyloric stenosis, cheek fat disappeared... Rejection of weight loss pyloric mass, stomach dilation, slow breathing

Mainly manifested as high gastrointestinal obstruction symptoms, such as vomiting, gastric peristalsis in the upper abdomen and pyloric mass touching the hypertrophy.

Vomiting

For the first symptom of this disease, children with congenital hypertrophic pyloric stenosis are usually asymptomatic after birth, milking and urination are normal, more than 2 to 3 weeks after birth, vomiting, a few cases after birth, spit, even It is late for 7-8 weeks to vomit. The premature infants have a late onset and start to have galactorrhea after eating. Occasionally, vomiting gradually increases. After each time, it will vomit after each milk. Vomiting occurs in a few minutes after the milk. General vomiting becomes jetting. When it is severe, it can be sprayed to a few feet away. It is often ejected from the mouth and nostrils. When the pyloric stenosis is immature, the vomiting is more typical. It is general vomiting, no jetting, and the vomit is milk and Gastric juice or milk clot, without bile, may be brown (3% to 5%) when vomiting is severe. Later, due to the gradual expansion and relaxation of the stomach, the milk stays in the stomach for a long time, and the number of vomiting is less than before. Sometimes 1 or 2 times after the milk does not vomit, but the amount of spit after the next milk is often more than the amount of intake, the amount will be spit out twice, containing more milk clots, with sour taste, although vomiting frequently, but still after vomiting Have a strong appetite and show hunger, such as feeding again, can suck as usual Hey, the vomiting is heavier, the stool is reduced, the bowel movement is performed once a few days, the stool is dry, hard, and the urine volume is also reduced.

2. Gastric peristaltic wave

The abdominal examination showed that the upper abdomen was bulging, and the lower abdomen was flat and soft. About 95% of the children had gastric peristaltic waves in the upper abdomen. They moved from the left rib to the right upper abdomen and then disappeared. Sometimes two waves appeared. Especially after feeding, it is easy to see, sometimes pat the abdominal wall by hand can also cause the appearance of gastric peristalsis. Gastric peristaltic wave is common in congenital hypertrophic pyloric stenosis, but it is not a unique sign, usually during feeding or after eating. It is easy to see that premature infants can also be seen under normal conditions and cannot be used as a basis for diagnosis.

3. Abdominal mass

The olive-like mass on the right upper abdomen is a unique sign of pyloric stenosis. If you can touch and combine the history of typical vomiting, you can determine the diagnosis, but this mass is not always easy to reach, the detection rate of the tumor is The examiner's experience, especially the degree of patience, is best checked when the sick child is asleep or in the mother's arms. At this time, the child sucks hard, the abdominal wall is slack, the doctor stands on the right side of the sick child, and the rectus abdominis in the right upper quadrant. At the outer edge, use the middle finger to gently massage deeper, you can touch the harder pyloric mass of olive-shaped texture, sometimes because the position of the mass is deep, covered by the liver, not easy to touch, then put your left hand behind the sick child Slightly lift it up, the right middle finger will push the liver edge up and then touch it deep. As long as you patiently and carefully check it again, almost all cases can touch the mass. Premature infants have poor abdominal muscle development, thin abdominal wall and easy to touch. .

4. Dehydration and malnutrition

Due to the progressive increase of vomiting, insufficient intake, often dehydration, initial weight loss, and then rapidly decline, day weight loss, such as 2 to 3 weeks of onset of untreated children, their body weight can be 20% lower than the birth weight Left and right, showing malnutrition, subcutaneous fat reduction, skin relaxation, dryness, wrinkles, loss of elasticity, anterior and eyelid depression, cheek fat disappeared, showing the face of the elderly.

5. Alkali poisoning

Due to long-term vomiting, loss of a large amount of gastric acid and potassium ions, can cause low chlorine, low potassium alkalosis, clinical manifestations of slow breathing, due to lower free calcium in the blood, can cause low calcium sputum, manifested as hand and foot sputum, throat , tonic convulsions, etc., but if the child is dehydrated seriously, kidney function is low, acidic metabolites are retained in the body, some alkaline substances are neutralized, so there are few obvious cases of alkali poisoning, and a few advanced cases even have metabolic acid Poisoning-based, manifested as apathetic, refusal to eat, pale complexion.

6. Huang Wei

2% to 3% of children with jaundice, mainly indirect bilirubin increased, jaundice gradually disappeared after surgery, jaundice causes and calories, dehydration, acidosis affects hepatocyte glucuronyltransferase activity, and delayed stool discharge Intestinal and hepatic circulation; sometimes there is a direct increase in bilirubin, and a hypertrophic pyloric compression of the common bile duct produces mechanical obstruction; autonomic imbalance, causing sputum in the common bile duct; dehydration-induced bile concentration and siltation.

Examination of congenital hypertrophic pyloric stenosis

Routine should check blood sodium, potassium, chlorine, magnesium and blood pH, check liver, kidney function and bilirubin concentration, fecal occult blood test.

1. Abdominal X-ray film and barium meal angiography

(1) Abdominal X-ray film: The abdominal X-ray film shows the expansion of the stomach, the lower boundary of the stomach reaches below the level of the second lumbar vertebra, and the intestinal gas is reduced; the gastric peristaltic wave is seen in the lying position.

(2) Barium meal examination: For cases where the mass is not touched, a X-ray examination of the barium meal should be performed, and a typical X-ray change can be found to confirm the diagnosis. After the sick child is diluted, the stomach can be displayed under different degrees of X-ray. Dilation, increased peristalsis, can have gastroesophageal reflux, expectorant to the pylorus to stop or only a few tincture into the duodenum.

Apparently prolonged, normal infants have a gastric emptying time of 2.5 to 3 hours, and pyloric stenosis is not empty after 6 to 10 hours. Even after 24 hours, there is still sputum remaining in the stomach. More importantly, if you can patiently observe it in the right anterior oblique position, It can be seen that the pyloric tube is slender and narrow, showing a "line-like sign", extending by 1 to 3.5 cm; the pyloric hypertrophic ring muscle compresses the gastric antrum, showing "shoulder sign"; pressing the base of the duodenal bulb to make the duodenum The ball is like a mushroom-like change, called ""; the pyloric tube is not full, only the entrance to the pylorus is full, like a bird's beak, called "bird's mouth sign"; the edema of the mucosa is sandwiched in the center of the pyloric tube, parallel on both sides The tincture is filled, called "dual track sign", etc., the characteristic X-ray changes of congenital hypertrophic pyloric stenosis such as duodenal bulbar indentation, and the expectorant emptying is prolonged, and the expectorant should be sucked out to prevent aspiration.

2. Ultrasound examination

Diagnostic criteria for pyloric hypertrophy: pyloric tube long diameter > 16 mm, pyloric muscle thickness 4 mm, pyloric tube diameter > 14 mm, if the above three criteria are not met at the same time, only one or two meet the standard, then the ultrasound score System [2], with a score of 4, diagnosed as CHPS, 2 is negative, = 3 points, further examination is recommended, ultrasound image of CHPS: hypertrophic pyloric ring muscle is substantially medium or low echo mass, clear outline, The boundary is clear, the central mucosa of the pyloric tube is strongly echoed, and the pyloric lumen is linear and silent. When the gastric peristalsis is strong, a small amount of liquid can be seen through the pyloric tube. Some people have proposed a stenosis index greater than 50% as the diagnostic criteria, and can observe the pyloric tube. The opening and closing and food passage, it was found that a few cases of pyloric tube open normal: called non-obstructive pyloric hypertrophy, follow-up observation of the mass gradually disappeared.

3. Endoscopy

It can be seen that the pyloric tube is a cauliflower-like stenosis, the lens cannot pass through the pyloric tube, and there is gastric retention, and the diagnosis rate is 97%.

Diagnosis and diagnosis of congenital hypertrophic pyloric stenosis

diagnosis

According to the typical clinical manifestations, three major signs of gastric peristalsis, sputum and pyloric mass and jet vomiting can be seen. The most reliable diagnosis is to touch the pyloric mass. If the mass is not touched, Perform a real-time ultrasound or barium meal check to help confirm the diagnosis.

(1) Diagnostic criteria for ultrasonographic examination of pyloric hypertrophy: pyloric tube long diameter > 16 mm, pyloric muscle thickness 4 mm, pyloric tube diameter > 14 mm, if the above three criteria are not simultaneously achieved, only one or two meet the standard , using the ultrasound scoring system [2], the diagnosis is CHPS when the score is 4, negative when 2, further examination is recommended when = 3 points, ultrasound image of CHPS: hypertrophic pyloric ring muscle is substantially medium or low echo group Block, clear outline, clear border, strong echo in the central mucosa of the pyloric tube, the pyloric lumen is linear and silent, when a small amount of fluid passes through the pyloric tube when the gastric peristalsis is strong, a narrow index of more than 50% is proposed as the diagnostic criteria. Attention can be paid to the observation of the opening and closing of the pyloric canal and the passage of food. It has been found that a few cases of pyloric canal opening are normal: called non-obstructive pyloric hypertrophy, and the mass disappears after follow-up observation.

(2) The main basis for the examination and diagnosis of barium meal is the pyloric lumen growth (>1cm) and the narrow (<0.2cm). The gastrointestinal fluoroscopy shows that the anterior pyloric region is "bird-like" protruding, and the pyloric tube is slender and "line". Symptoms, the antrum and stomach cavity are enlarged, the stomach is filled with the light spots of the contents and the liquid dark area echoes, and the gastric peristalsis phenomenon is enhanced and enhanced, sometimes the signs of reverse peristaltic waves, delayed gastric emptying, etc., and follow-up examination of the pylorus In the case of myotomy, this sign is still seen for several days. Afterwards, the pyloric tube becomes shorter and wider, and may not return to the normal state. After the examination, the expectorant should be aspirated through the gastric tube and the stomach should be washed with warm saline. Inhalation pneumonia occurs to avoid vomiting.

The abdominal examination should be placed in a comfortable position, lying on the mother's lap, the abdomen is fully exposed, and under the bright light, when feeding the sugar water, the stomach type and peristaltic wave can be seen, and the waveform appears under the left costal margin. Slowly over the upper abdomen, one or two waves advance, and finally disappear to the right side of the umbilicus. The examiner is on the left side of the baby. The technique must be gentle. The left hand is placed at the outer edge of the right rectus abdominis, with the index finger. Press the rectus abdominis with the ring finger and gently touch the middle finger to the deep part. It can touch the olive-shaped, smooth and hard pyloric mass. It is 1~2cm in size. It is easy to sputum after the stomach is empty and the abdominal muscles are temporarily slack after vomiting. Occasionally, the tail or right kidney of the liver is mistaken for a pyloric mass, but if the abdominal muscles are not slack or the stomach is dilated, the stomach tube can be drained, and the sugar water is sucked and checked. Inspection, according to experience, most cases can get a lump.

Laboratory tests can find that infants with clinically dehydrated water have varying degrees of hypochlorine alkalosis, elevated blood Pco2, elevated pH and serum low chlorine, and must be aware that metabolic alkalosis is often accompanied by low The phenomenon of potassium, the mechanism is still unclear, a small amount of potassium is lost with gastric juice, potassium ions move into the cells during sputum poisoning, causing high potassium in the cells, while extracellular low potassium, potassium in the renal distal convoluted epithelial cells Increase, so blood potassium is reduced.

Differential diagnosis

There are various causes of vomiting in infants. They should be differentiated from various diseases such as improper feeding, systemic or local infections, pneumonia and congenital heart disease, central nervous system diseases that increase intracranial pressure, progressive kidney disease, infection. Gastroenteritis, various intestinal obstructions, endocrine diseases, and gastroesophageal reflux and esophageal hiatus hernia.

1. The pyloric sputum is vomiting after birth, which is intermittent and irregular vomiting; the number of vomiting is variable, the amount of vomiting is also small, the degree of vomiting is light, and there is no jet vomiting. Therefore, although the sick child may have mild Weight loss, but no severe dehydration and malnutrition, a small number of sick children can see the gastric peristaltic wave, but no lumps, X-ray examination only mild pyloric obstruction changes, no typical pyloric stenosis images, sedatives and atropine The effect is good and the symptoms can disappear.

2. anterior pyloric pyloric anterior valve is a rare congenital gastrointestinal malformation. There is a valve composed of mucosa and submucosal tissue in the pylorus or sinus, separating the stomach from the duodenum, the valve Some are complete, some have holes, complete valve after the birth, there is complete obstruction symptoms, the time of the symptoms of the perforated valve is different, generally more in the neonatal period, the main symptoms are vomiting, mostly after feeding, often It is sprayable, the sputum is milk, no bile, and common gastric peristaltic wave. It is clinically similar to pyloric stenosis. It is difficult to identify, but the pyloric anterior valve has no hypertrophic pyloric mass in the right upper abdomen. In addition to the pyloric stenosis, there is no pyloric tube extension, bending and duodenal bulbic pressure traces such as hypertrophic pyloric stenosis, the X-ray image of the disease, the disease is sedative, antispasmodic treatment is invalid, only surgical incision or resection The pyloric valvuloplasty of the valve can achieve good results.

3. refers to the congenital sacral esophageal muscle persistent obstruction caused by high esophageal obstruction and high expansion and hypertrophy of the esophagus itself, so it is also known as congenital giant esophagus, ultrasound manifests as esophageal dilation after drinking water is fusiform or flask-shaped, dilated The lower esophagus is narrow in the beak or brush-like shape, becomes long, the water is blocked, the early wall is thickened, the narrow lumen is open when deep exhalation, the water flow passes, the abdominal cavity pressure increases during deep inhalation, the water flow passes, and the late obstruction is local Because the scar obstructs the contraction of the cardia, causing a certain reflux of the gastroesophageal tract, the stomach cavity is almost not filled, and some of the abdominal cavity esophagus expands and accumulates.

4. Stomach torsion is more than overflowing milk or vomiting after birth, vomiting can occur within a few weeks, vomit is milk, does not contain bile, even sprayed, usually after feeding, especially when moving sick children vomiting Obviously, there is no positive sign in the abdomen, and X-ray examination of barium meal can confirm the diagnosis. The X-ray features are: the esophageal mucosa and the gastric mucosa have a cross phenomenon; the stomach curvature is located above the small bend; the location of the pyloric sinus is higher than the duodenal bulb Department; double stomach bubble, double liquid plane; esophageal abdominal segment extended and open under the stomach, etc., using body feeding method, that is, still in situ after feeding, flattening after half an hour or 1 hour, usually 3 to 4 months later symptoms Naturally lighten or disappear.

5. Gastroesophageal reflux due to dysplasia of the lower esophageal sphincter, lack of muscle tension in the gastric cardia, often in an open state, sick children often vomiting within a few days after birth, especially after feeding the sick child to vomit, such as Immediately prevent the sick child from being erected. The X-ray fluoroscopy of the sputum meal is open to the sputum, and the contrast agent can be diagnosed by reversing into the esophagus.

6. Improper feeding Because of excessive feeding, urgency, or artificial feeding, the bottle is inhaled into the stomach due to tilting of the bottle, or improperly placed after feeding, etc., are common causes of vomiting in newborns, such as vomiting caused by improper feeding. Should prevent excessive feeding too fast, hold the child after eating, pat the back to make the gas accumulated in the stomach discharge, vomiting can stop.

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