Symptom >> Internal Medicine >> Gastroenterology

Pyloric stenosis

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Congenital hypertrophic pyloric stenosis (congenital hypertrophic pylorosis) is a common abdominal deformity in newborns. There are many male infants, and the ratio of male to female is about 10:1. Due to the difficulty of food passage, the child's nutrition will have serious obstacles. If left untreated, it can lead to death. The cause of this disease has not been satisfactorily explained so far. It is believed that there may be dysplasia or lack of plexus between the pyloric muscles, resulting in poor pyloric sphincter relaxation, which is related to compensatory hypertrophy of the pyloric muscle of the stomach.

Cause

Cause

The cause of pyloric tube stenosis:

The cause of this disease has not been satisfactorily explained so far. It is believed that there may be dysplasia or lack of plexus between the pyloric muscles, resulting in poor pyloric sphincter relaxation, which is related to compensatory hypertrophy of the pyloric muscle of the stomach. Its pathological features are hypertrophic hyperplasia of the pyloric sphincter, hard like cartilage, shaped like olives, severe stenosis of the pyloric tube, resulting in obvious mechanical obstruction.

Examine

an examination

Related inspection

Gastrointestinal CT examination of gastrointestinal diseases by ultrasound 14C breath test

Examination and diagnosis of pyloric tube stenosis:

More pyloric obstruction than the second or third week after birth:

a. nausea and vomiting, occurs immediately after eating or after 10 minutes, vomiting is jetting, spit is free of bile, and early cases are galactorrhea.

b. It can be seen that the gastric peristaltic wave moving from the left rib to the right disappears to the right upper abdomen.

c. pyloric mass, about 90% of cases, can be in the right upper abdomen (generally between the lower edge of the liver and the outer edge of the rectus abdominis), can touch a 2 × 1cm size, the edge is clear, hard as the cartilage is spindle-shaped, surface A smooth lumps are best checked when the sick child is asleep or sucking.

d. Checking the meal, mixing the sputum into the milk, and seeing after eating, the lower end of the stomach is conical, with strong and deep peristaltic waves, suddenly disappearing in the pylorus, and few sputum into the duodenum. The agent is elongated in the pyloric cavity, and the gastric emptying is slow.

The eB type ultrasonic probe presents a hypoechoic mass (substantial dark area), which is located inside the gallbladder, in front of the right kidney and outside the pancreatic head during lateral scanning. The longitudinal scan is located behind the gallbladder. The diameter of the mass is about 1 cm, and the center has a round shape. Or a star-shaped image.

Diagnosis

Differential diagnosis

Differential diagnosis of pyloric tube stenosis:

1. pyloric fistula: more vomiting occurs after birth, intermittent, irregular vomiting; vomiting times are uncertain, spit out is also less; vomiting is mild, no jet vomiting. Therefore, although the sick child may have mild weight loss, there is no serious dehydration and malnutrition. A small number of sick children can see the gastric peristaltic wave, but there is no swelling. X-ray examination showed only a change in mild pyloric obstruction, and there was no image of typical pyloric stenosis. Good results with sedatives and atropine can make the symptoms disappear.

2. Pyloric anterior valve: The pyloric anterior valve is a rare congenital digestive tract malformation. A valve consisting of mucosal and submucosal tissue in the pylorus or sinus separates the stomach from the duodenum. The valve is complete and some have holes. Complete valvular symptoms appear after the valve is born. The time of appearance of a perforated valve is different, and it is usually more common in the neonatal period. The main symptoms are vomiting, which often occurs after feeding, often with jetting, spitting milk, no bile, and common gastric peristalsis. It is clinically similar to pyloric stenosis and difficult to identify. However, the pyloric anterior valve has no hypertrophic pyloric mass in the right upper abdomen. In addition to the pyloric stenosis in the X-ray examination of the pyloric meal, there is no specificity of hypertrophic pyloric stenosis such as pyloric tube extension, bending and duodenal sulcus. X-ray image. The disease is ineffective with sedation and antispasmodic treatment, and only scleroplasty can be performed by surgical incision or resection of the valve to achieve good results.

3. : refers to the congenital anastomosis of the esophageal muscle caused by persistent esophageal muscle obstruction and high expansion and hypertrophy of the esophagus itself, so it is also called congenital giant esophagus. Ultrasound showed that the dilatation of the esophagus after drinking water was fusiform or flask-shaped, and the esophagus in the lower part of the dilatation was narrow or longer in the shape of a bird's beak or a brush, and the water was blocked. In the early stage, the wall was thickened, and in the deep exhalation, the narrow lumen was open and the water flowed through. During deep inhalation, the abdominal pressure increases and no water flows through. Lateral obstruction due to scars hindered the contraction of the cardia, causing a certain gastroesophageal reflux, the gastric cavity was almost not filled, and some showed dilatation and effusion above the esophagus.

4. Stomach torsion: more than spilled milk or vomiting after birth, vomiting can also occur within a few weeks. The vomit is milk, does not contain bile, and is even sprayed. Generally, after feeding, especially when moving the sick child, vomiting is more obvious, and there is no positive sign in the abdomen. X-ray examination of barium meal can confirm the diagnosis. The X-ray features: the esophageal mucosa and the gastric mucosa have a crossover phenomenon; the large curvature of the stomach is located above the small bend; the location of the pyloric sinus is higher than the duodenal bulb; the double gastric vesicle, the two-liquid plane; the esophageal abdominal segment is prolonged and Open under the stomach and so on. The posture feeding method is adopted, that is, it remains in situ after feeding, and is flattened after half an hour or 1 hour, and the symptoms are naturally alleviated or disappeared after 3 to 4 months.

5. Gastroesophageal reflux: Due to dysplasia of the lower esophageal sphincter, the gastric cardia lacks muscle tension and is often open. Most of the sick children have vomiting within a few days after birth, especially when the sick child is flattened and vomiting occurs. If the sick child is vertical, it can be prevented immediately. The X-ray of the meal is seen in the open door, and the contrast agent can be diagnosed by reverse flow into the esophagus.