Pyloric stenosis
The pyloric stenosis describes a narrowing of the gastrointestinal output. This can be congenital or acquired. It leads to a disturbed propagation of gastric contents into the duodenum, thus insatiable vomiting. Treatment is usually surgical correction of the constriction.
- 2.1 causes
- 2.2 symptoms
- 2.3 diagnosis
- 2.4 therapy
Congenital pyloric stenosis
When pylorus spasm ( pylorusmyohypertrophie; engl: Pylorospasm. ) Does not open the pylorus, the muscle that closes off the stomach to the duodenum, durable and can no longer pass through the stomach contents. The ongoing tension over time causes a thickening of the muscle.
Occurrence and causes
The disease has already been created with the birth and comes familial ago (possibly hereditary ). The causes are unknown as yet. To find the disease is mainly in western and northern Europeans with a frequency of 1:300, rare in Asians and almost never in Africans. The peak incidence is three weeks after the birth. The disease occurs (ratio of boys: girls: 4-5: 1) especially for the first-born boys.
Symptoms
The infant vomits (not bilious ) about half an hour after the meal, the food gush partially or completely. By stomach irritation can find blood in the vomit threads. Then, it looks for food again. Immediately after a meal increased gastric motility ( peristalsis) can be observed on the ventral surface in the upper abdomen. Some of the enlarged pylorus is palpable. The affected children are malnourished by the disabled passage of food, underweight, constantly hungry and dissatisfied accordingly. Put hunger chairs of low mass in high frequency.
Risks
The lack of food intake and repeated vomiting can lead to severe metabolic derangements (eg " Coma pyloric " ) and cause dehydration. Therefore, often a supply of fluids by infusion is required.
Diagnosis
The diagnosis is based on symptoms and by means of ultrasound, which makes the hypertrophic Pylorusmuskel visible. As a result of vomiting is because of the gastric juice loss a chloride deficiency, which leads to a disturbance of the acid- base balance in terms of metabolic alkalosis. Due to the alkalosis potassium is increased from the blood into cells, so that there is hypokalemia.
Clinically unclear cases, x-ray diagnosis can be performed. On the abdominal radiograph a large gastric bubble is striking. The diagnosis for distinguishing similar diseases can be secured through the gastrointestinal passage of contrast agent.
Therapy
Conservative
Until the definitive surgical treatment to correct the frequent in chronic vomiting dehydration and alkalosis occurs. Furthermore, antispasmodics and small meals.
Operational
The pyloric stenosis is treated almost exclusively by surgery. Here is the pylorus to the mucosa, which is maintained, split lengthwise ( pyloromyotomy according to Weber - Ramstedt ). Few hours after the surgery, the infant may be accustomed back to the normal diet.
Differential Diagnosis
To be distinguished are other changes with obstruction of gastric emptying, eg Duodenal obstruction, as part of a malrotation of the intestine. A disease with similar symptoms is the adrenogenital syndrome ( AGS). The vomiting is typically " limp ". In contrast to pyloric stenosis at the AGS, however, the potassium level in the blood is normal or increased.
Acquired pyloric stenosis
Causes
Acquired pyloric stenosis can be caused by inflammation, gastric or duodenal ulcers or tumors of the stomach and adjacent organs. As a rule, however, arises idiopathic, ie. , Without apparent cause There is a significantly higher incidence in boys, so that a genetic component is likely.
Symptoms
Stasis of chyme, fetor, vomiting, dehydration, hypochloremic alkalosis, significant gastric peristalsis, weakness, marasmus or cachexia
Diagnosis
Usually the diagnosis is made by the very typical constellation of symptoms and a subsequent ultrasound examination. In this case, a measurement of the wall thickness and the length of the pylorus and an assessment of peristalsis in the stomach, the retrograde, so backward, movement of chyme shows in the presence of Pylorushypertrophie in the stomach. In addition, a determination of the electrolytes is carried in the blood, where especially the chloride level and the base excess is crucial. If a secondary cause into consideration, is often a gastroduodenoscopy ( gastroscopy ) or another imaging technique to choose, preferably magnetic resonance imaging.
Therapy
According to the underlying disease different surgical procedures are available ( pyloroplasty, resections, gastrectomy, pancreaticoduodenectomy kephale ).