Hypertrophic Pyloric Stenosis

Hypertrophic pyloric stenosis is an obstruction of the Pyloruslumens by Pylorusmuskelhypertrophie.

Hypertrophic pyloric stenosis can lead to an almost complete gastric outlet obstruction. It affects 2 to 3 of 1000 infants and is more common in infants male with a 5: 1 ratio, especially in the first-born males. It occurs most often in 3 to 6 weeks of age and rarely after the 12th week. The specific etiology is uncertain, but there is evidence of a genetic component, as siblings and children of victims have a higher risk of disease, especially identical twins. Maternal smoking during pregnancy increases the risk. The cause an insufficient NO synthesis, abnormal innervation of the muscular layer and hypergastrinemia be discussed. Infants who received in the first weeks of life, certain macrolide antibiotics (eg., Erythromycin), have a significantly higher risk of disease.

Hypertrophic pyloric stenosis is an obstruction of the Pyloruslumens by Pylorusmuskelhypertrophie. Hypertrophic pyloric stenosis can lead to an almost complete gastric outlet obstruction. It affects 2 to 3 of 1000 infants and is more common in infants male with a 5: 1 ratio, especially in the first-born males. It occurs most often in 3 to 6 weeks of age and rarely after the 12th week. The specific etiology is uncertain, but there is evidence of a genetic component, as siblings and children of victims have a higher risk of disease, especially identical twins. Maternal smoking during pregnancy increases the risk. The cause an insufficient NO synthesis, abnormal innervation of the muscular layer and hypergastrinemia be discussed. Infants who received in the first weeks of life, certain macrolide antibiotics (eg., Erythromycin), have a significantly higher risk of disease. Symptoms and signs The symptoms typically develop 3 to 6 weeks of age. Schwall-like vomiting (without bile) occurs shortly after feeding. Until it comes to dehydration, the child can feed almost greedy and looks good, as opposed to children with vomiting due to systemic diseases. A peristaltic wave of the stomach may be visible, which crosses the epigastrium from left to right. A discrete, 2-3 cm wide, fixed and mobile olive-like pyloric roll can sometimes be palpated deep on the right side of the epigastrium. With progressive disease of the infant grows no more, signs of dehydration (dehydration in children: symptoms) develop. Diagnostic sonography hypertrophic pyloric stenosis should be suspected in all infants during the first months of life with projectile vomiting. The diagnosis is made by abdominal ultrasonography, showing an increase in thickness of the pylorus (typically ? 4 mm, normal <2 mm), together with an elongated pylorus (> 16 mm). In uncertain diagnostic ultrasound examination, a Bariumschluck are repeatedly performed serially or in which typically shows a delayed gastric emptying and the typical Schnürungszeichen or “railroad track-sign of” significantly narrowed, elongated Pyloruslumens. In rare cases, a gastroscopy to confirm the diagnosis is necessary. The classical electrolyte disturbances that shows a child with pyloric stenosis, is a hypochloraemic, metabolic alkalosis (hydrochlorischer due to loss of acid and simultaneous Hypovolämie- Metabolic alkalosis). About 5 to 14% of children have jaundice and about 5% Malrotation (malrotation of the intestine). Surgery Treatment (pyloromyotomy) Initial treatment is the correction of the electrolyte imbalance and hydration. The final treatment is carried out by longitudinal Pylorusmyotomie that leaves the mucosa intact and only the muscle fibers separated. Postoperatively, the infant tolerates the food within a day. Important points projectile vomiting occurs in a <3-month-old infant shortly after feeding. The diagnosis is made by ultrasound. The treatment is surgical incision of the hypertrophied Pylorusmuskels.

Health Life Media Team

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