Cheek fat disappears, looks older

Introduction The disappearance of buccal fat is one of the symptoms of 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.

Cause

1. Genetic factors play an important role in 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 incidence of children with a narrow history can be as high as 6.9%. If the mother has this history, the probability of a child is 19%, and the woman is 7%. The father has a history of 5.5% and 2.4%, respectively. It is pointed out that the genetic mechanism of pyloric stenosis is polygenic, neither recessive nor non-sexual, but a directed genetic gene consisting of a dominant gene and a sexually modified multifactor. This genetic predisposition is subject to certain environmental factors. And the role, such as social class, diet, various seasons, etc., the incidence is high 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 is mainly engaged in the research of pyloric myenteric plexus. It is 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. In the past, the theory of pyloric ganglion cell degeneration caused lesions, using histochemical analysis to determine the activity of enzymes in the pyloric ganglion cells; but there are also dissidents, the ganglion cells with pyloric stenosis are observed to have no similarities with the fetus, such as The ganglion cell dysplasia is the cause, the premature infants should have more morbidity 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 observed by immunofluorescence technique. The number of neuropeptides containing enkephalin and vasoactive intestinal peptide in the ring muscle was significantly reduced, and the content of substance P in the tissue was decreased by radioimmunoassay. It is speculated that the changes of these peptides are related to the pathogenesis.

3. Gastrointestinal hormones have been administered to pregnant dogs to take pentagastrin gastrin. 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 months of pregnancy. According to this, pregnant women in the late pregnancy due to emotional anxiety caused by elevated serum gastrin concentration, and through the placenta into the fetus, the fetal genetic genetic role, causing long-term pyloric obstruction, pyloric expansion and stimulate G cells secrete gastrin, Therefore, the onset of the disease, but other scholars repeatedly measured gastrin, some reports increased, but some did not change abnormally, even in cases of elevated gastrin, can not be inferred to be the cause or result of pyloric stenosis, because 1 week after surgery In some cases, gastrin returned to normal levels, and some increased. In recent years, gastrointestinal stimulating hormones were studied, and the concentrations of prostaglandins (E2 and E2a) in serum and gastric juice were measured, suggesting that the content of gastric juice in children increased significantly. The pathogenesis is that the local hormone concentration in the pyloric muscle layer is increased, the muscle is in a state of constant tension, and the disease is caused. Some people have studied the serum cholecystokinin. No abnormal changes.

an examination

Related inspection

Gastric sputum angiography, ultrasound examination of gastrointestinal diseases, blood electrolyte examination

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 ultrasound examination of pyloric hypertrophy: pyloric tube long diameter >16mm, pyloric muscle thickness 4 mm, pyloric tube diameter>14mm, if the above three criteria are not simultaneously achieved, only one or two meet the standard, The ultrasound scoring system is used. When the score is 4, the diagnosis is CHPS 2, and when the score is 3, it is recommended to further check. The ultrasound image of CHPS, the hypertrophic pyloric ring muscle is substantially medium or low echo, and the outline is clear. 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.

(B), the main basis for barium meal examination and diagnosis is pyloric lumen growth (> 1cm) and narrow (<0.2cm), gastrointestinal fluoroscopic presentation of the pyloric area is "bird's beak-like" prominent, pyloric tube slender " Line-like sign, the antrum and stomach cavity are enlarged, the light spot filled in the stomach and the liquid dark area echo, the gastric peristalsis phenomenon is enhanced and enhanced, sometimes the signs of reverse peristaltic wave, delayed gastric emptying, etc., follow-up review In the case of pyloric muscle incision, this sign has been seen for several days. Afterwards, the pyloric tube becomes shorter and wider, and may not return to the normal state. After the examination, the sputum must be sucked out through the gastric tube, and the stomach is washed with warm saline. In order to avoid vomiting and aspiration pneumonia.

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

Face is old and old:

1. More elderly women than men.

2, daze, lethargy, depression.

3, weight loss, fatigue, face and old age.

4, dry skin, rough and less sweat.

5, eyelid edema drooping, but obvious eye is less common.

6, the thyroid gland is nodular or adenoma or cystadenoma changes more.

7, muscle atrophy, body size and a number of cachexia state.

8, arrhythmia, there are many atrial fibrillation or sinus arrhythmia, the general heart rate is 90 ~ 120 times / min, with heart enlargement, insufficient blood supply or chronic heart failure.

9 The condition is heavier and the performance is atypical. It is easy to be misdiagnosed and cannot be properly treated. It can cause hyperthyroidism crisis; more than 10 cases of anemia, stomach disease, hypertension, hyperlipidemia, hyperviscosity and immune dysfunction.

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